title: 5-year survival and clinical prognostic factors in progressive supratentorial diffuse "low-grade" astrocytoma: a retrospective analysis of 46 cases.
abstract: In order to study survival and identify prognostic factors in progressive supratentorial low grade astrocytoma, 46 cases of diffusely growing glioma (1982-1989), in which stereotactic biopsy revealed a diagnosis of astrocytoma grade II according to Kernohan, were evaluated. Only patients with definite tumour growth on consecutive CT scans were included. All patients received a full course of fractionated radiotherapy. All tumour biopsy specimens were re-evaluated according to both the Kernohan and Daumas-Duport grading systems. Follow-up for at least 5 years showed a median survival of 47.5 months (1 year 71%, 5 year 41%). In Cox' multivariate analysis 4 factors turned out to give the best fitting prognostic model for survival: age, duration of symptoms, pre-operative neurological examination and CT-contrast enhancement. Numerical scoring was performed by giving either 1 or 0 for: age > or < 40 years, symptom duration < or > 1 year, presence or absence of focal deficit, and presence or absence of CT-contrast enhancement. Combining these factors in a score ranging from 0-4 resulted in 3 distinct groups with respect to median survival (< 2:66.5 months, 2:40 months, > 2:10 months, P = 0.0015). Although 17 cases with Kernohan grade II were upgraded using Daumas-Duport criteria (13 grade III, 4 grade IV), these cases did not form a separate survival-group. Additional parameters are needed to assess prognosis by neuropathological means, as some "low-grade" tumours are less benign than others, giving rise to a variable natural history.
authors.affiliation: Department of Neurosurgery, University of Amsterdam, The Netherlands.
authors.forename: P R
authors.initials: PR
authors.lastname: Schuurman
authors.forename: D
authors.initials: D
authors.lastname: Troost
authors.forename: B
authors.initials: B
authors.lastname: Verbeeten
authors.forename: D A
authors.initials: DA
authors.lastname: Bosch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed