Parathyroid hormone-related protein expression is correlated with clinical course in patients with glial tumors.
BACKGROUND
Parathyroid hormone-related protein (PTHrP) expression modulates cell survival in a number of human solid tumors. Although PTHrP is expressed in normal developing and neoplastic central nervous system tissue, clinical data indicating the importance of this protein with respect to local control and/or survival in patients with glial tumors are scarce.


METHODS
Using a standard immunoperoxidase technique, the authors examined PTHrP expression in a population of 51 patients with Daumas-Duport Grade II-IV astrocytomas over a 15-year period. Both local control and survival were calculated from the date of definitive irradiation to the last time of known follow-up examination using the actuarial method. PTHrP expression was scored on examination under 40x magnification, with the incidence of cellular staining averaged over 10 high-power fields. The intensity and extent of staining were characterized semiquantitatively using the standard World Health Organization classification criteria. The median follow-up duration was approximately 5.5 years. Multivariate analyses were performed to ascertain the statistical significance of several standard clinicohistopatholgic factors (Karnofsky functional status, age, gender, extent of surgical resection, radiotherapy dose, grade, and PTHrP expression) with respect to local control and survival. P < 0.05 was considered indicative of statistical significance.


RESULTS
Patients with high levels of PTHrP expression had significantly lower glial tumor local control rates and corresponding decreases in progression-free and overall actuarial survival after definitive irradiation (P < 0.01). In a Cox 3-variable model, the PTHrP staining score was independent of tumor grade or Karnofsky functional status. It is notable that the strongest predictor of survival was tumor grade (P < 0.001).


CONCLUSIONS
PTHrP may be an important adjunct to standard immunopathologic criteria in the determination of glial tumor responses. A number of mechanisms were explored to derive a more mechanistic understanding of these translational results. Subsequent prospective studies involving larger patient populations will be necessary before findings can be translated to clinical practice.
Pardo
Francisco S
FS
Division of Radiation Oncology, Department of Radiology, University of California-San Diego School of Medicine, San Diego, California, USA. fpardo@ucsd.edu
Lien
Winston W
WW
Fox
Howard S
HS
Efird
Jimmy T
JT
Aguilera
Joseph A
JA
Burton
Douglas W
DW
Deftos
Leonard J
LJ
D016543:Central Nervous System Neoplasms / Q000235:genetics* / Q000473:pathology* / Q000532:radiotherapy; D018572:Disease-Free Survival; D015972:Gene Expression Regulation, Neoplastic; D005910:Glioma / Q000235:genetics* / Q000473:pathology* / Q000532:radiotherapy; D006801:Humans; D007150:Immunohistochemistry; D015999:Multivariate Analysis; D044162:Parathyroid Hormone-Related Protein / Q000096:biosynthesis*; D011379:Prognosis; D012189:Retrospective Studies
D044162:Parathyroid Hormone-Related Protein