title: Prognostic implication of clinical, radiologic, and pathologic features in patients with anaplastic gliomas.
abstract: BACKGROUND
  The clinical evolution of anaplastic glioma (anaplastic astrocytoma, oligodendroglioma, and oligoastrocytoma) is variable. Previous studies merged patients with anaplastic glioma and the much more common glioblastoma multiforme. Therefore, the conclusions on prognostic factors reflected in part the consequences of an analysis in a heterogeneous population.
  
  
  METHODS
  To identify clinical, neuroradiologic, pathologic, and molecular factors with prognostic significance, we analyzed 95 treated patients with a histologic diagnosis of anaplastic glioma. Variables included age, gender, clinical manifestations at diagnosis (seizures, focal neurologic deficit, and cognitive changes), computed tomographic (CT) scan characteristics (diffuse, ring, and no enhancement), tumor location, extent of resection, histopathology, postoperative Karnofsky performance status (KPS) score, adjuvant chemotherapy, tumor response, proliferation index (Ki-67 expression), and p53, p16, pRb, and epidermal growth factor receptor immunohistochemical expression.
  
  
  RESULTS
  Ninety-five patients with a histologic diagnosis of anaplastic astrocytoma (73%), anaplastic oligoastrocytoma (16.6%), or anaplastic oligodendroglioma (10.4%) constituted the basis of this study. Median overall survival was 29 months. Multivariate analysis revealed that an age of 49 years or younger (P < 0.03), postoperative KPS score of 80 or higher (P < 0.007), absence of ring enhancement (P = 0.03), and a proliferation index of 5.1% or lower (P = 0.044) were independently associated with longer survival. The presence of an oligodendroglial component was associated with better prognosis in the univariate analysis (P = 0.009), although this lost power in the multivariate analysis.
  
  
  CONCLUSIONS
  In addition to previously recognized prognostic variables such as age and KPS score, CT ring enhancement and tumor proliferation index were identified as independent predictors of survival in a homogeneous series of patients with anaplastic gliomas.
authors.affiliation: Neuropathology Institute of Catalonia, Bellvitge Hospital CSUB, L'Hospitalet, Spain.
authors.forename: Avelina
authors.initials: A
authors.lastname: Tortosa
authors.forename: Núria
authors.initials: N
authors.lastname: Viñolas
authors.forename: Salvador
authors.initials: S
authors.lastname: Villà
authors.forename: Eugènia
authors.initials: E
authors.lastname: Verger
authors.forename: Juan M
authors.initials: JM
authors.lastname: Gil
authors.forename: Marta
authors.initials: M
authors.lastname: Brell
authors.forename: Lluís
authors.initials: L
authors.lastname: Caral
authors.forename: Teresa
authors.initials: T
authors.lastname: Pujol
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Acebes
authors.forename: Teresa
authors.initials: T
authors.lastname: Ribalta
authors.forename: Isidre
authors.initials: I
authors.lastname: Ferrer
authors.forename: Francesc
authors.initials: F
authors.lastname: Graus
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D002772:Cholera Toxin; D019941:Cyclin-Dependent Kinase Inhibitor p16 / Q000032:analysis; D005260:Female; D005910:Glioma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007150:Immunohistochemistry; D017567:Karnofsky Performance Status; D019394:Ki-67 Antigen / Q000032:analysis; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011859:Radiography; D016019:Survival Analysis; D016159:Tumor Suppressor Protein p53 / Q000032:analysis
chemical_list: D019941:Cyclin-Dependent Kinase Inhibitor p16; D019394:Ki-67 Antigen; D016159:Tumor Suppressor Protein p53; D002772:Cholera Toxin