title: Overall survival in patients with malignant glioma may be significantly longer with tumors located in deep grey matter.
abstract: BACKGROUND
  The aim of this study was to assess the correlation of overall survival with tumor location (lobar vs. deep grey matter) and with other clinical and imaging variables in a cohort of patients with high grade gliomas.
  
  
  METHODS
  Adult patients with newly diagnosed supratentorial WHO grade 3 and 4 gliomas were evaluated. Clinical data included demographics, symptoms at presentation, treatment variables, and overall survival. Radiological data included tumor side, site (deep vs. lobar) and size, extent of peritumoral edema, and presence of midline shift. Biostatistics were carried out using log rank tests and univariate and multivariate Cox regression models.
  
  
  RESULTS
  A total of 121 patients were investigated, 23 (19.0%) with WHO grade 3 and 98 (81.0%) with WHO grade 4 gliomas. Tumors had lobar location in 96 cases (79.3%) and deep grey matter location in 25 cases (20.7%). Median survival time for all patients was 26 weeks (IQR: 14-53). Patients with deep tumors survived significantly longer than those with lobar gliomas (log rank test, p=0.0083). Extensive brain edema significantly shortened survival (log rank test, p=0.0003). Presence of midline shift (>1 cm) was a statistically significant risk factor for shorter survival (log rank test, p<0.0001). The univariate Cox regression model demonstrated statistical significance for the variables age, side, site and size of tumor, presence of extensive edema, and presence of mass effect (>1 cm). In the multivariate Cox models, tumor grade, site and size showed statistical significance.
  
  
  CONCLUSIONS
  This study suggests that patients with deep grey matter gliomas may survive significantly longer after the initial diagnosis than those with tumors in a lobar location. This is a potentially novel finding, which may corroborate the theory of differential invasion of glioma cells in different microenvironments of the brain, but remains to be confirmed in future prospective studies.
authors.affiliation: Department of Neurosurgery, The Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ, UK.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Ramnarayan
authors.forename: Susanna
authors.initials: S
authors.lastname: Dodd
authors.forename: Kumar
authors.initials: K
authors.lastname: Das
authors.forename: Volkmar
authors.initials: V
authors.lastname: Heidecke
authors.forename: Nikolai G
authors.initials: NG
authors.lastname: Rainov
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001254:Astrocytoma / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D002648:Child; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000000981:diagnostic imaging / Q000473:pathology; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D011379:Prognosis; D012044:Regression Analysis; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D006113:United Kingdom / Q000453:epidemiology