Prognostic significance of anaplasia and angiogenesis in childhood medulloblastoma: a pediatric oncology group study.
The purpose of this study was to investigate whether quantitative assessment of cytologic anaplasia and angiogenesis may predict the clinical prognosis in medulloblastoma and stratify the patients to avoid both undertreatment and overtreatment. Medulloblastomas from 23 patients belonging to the Pediatric Oncology Group were evaluated with respect to some prognostic variables, including histologic assessment of nodularity and desmoplasia, grading of anaplasia, measurement of nuclear size, mitotic cell count, quantification of angiogenesis, including vascular surface density (VSD) and microvessel number (NVES), and immunohistochemical scoring of vascular endothelial growth factor (VEGF) expression. Univariate and multivariate analyses for prognostic indicators for survival were performed. Univariate analysis revealed that extensive nodularity was a significant favorable prognostic factor, whereas the presence of anaplasia, increased nuclear size, mitotic rate, VSD, and NVES were significant unfavorable prognostic factors. Using multivariate analysis, increased nuclear size was found to be an independent unfavorable prognostic factor for survival. Neither the presence of desmoplasia nor VEGF expression was significantly related to patient survival. Although care must be taken not to overstate the importance of the results of this single-institution preliminary report, pathologic grading of medulloblastomas with respect to grading of anaplasia and quantification of nodularity, nuclear size, and microvessel profiles may be clinically useful for the treatment of medulloblastomas. Further validation of the independent prognostic significance of nuclear size in stratifying patients is required.
Department of Pathology, School of Medicine, Dokuz Eylul University, Inciralti, Izmir 35340, Turkey. eozer@deu.edu.tr
Erdener
E
Ozer
Faik
F
Sarialioglu
Riza
R
Cetingoz
Nurullah
N
Yüceer
Handan
H
Cakmakci
Sermin
S
Ozkal
Nur
N
Olgun
Kamer
K
Uysal
Funda
F
Corapcioglu
Serefettin
S
Canda
D000293:Adolescent; D001808:Blood Vessels / Q000473:pathology; D002452:Cell Count; D002467:Cell Nucleus / Q000648:ultrastructure; D002528:Cerebellar Neoplasms / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000098:blood supply* / Q000378:metabolism / Q000473:pathology*; D008833:Microcirculation; D008938:Mitosis; D015999:Multivariate Analysis; D009389:Neovascularization, Pathologic / Q000378:metabolism / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
D042461:Vascular Endothelial Growth Factor A