title: Revisiting anaplastic astrocytomas I: an expansive growth pattern is associated with a better prognosis.
abstract: OBJECTIVE
  To study whether anaplastic astrocytomas that are nonenhancing and/or well-circumscribed (expansive) are associated with a better prognosis.
  
  
  METHODS
  We retrospectively identified 59 patients with pathologically confirmed World Health Organizaiton (WHO) grade III anaplastic astrocytoma who underwent craniotomy at our institution from 1995 through 2006. We assessed prognostic variables including age, enhancement (EAA-34 patients) vs. nonenhancement (NEAA-25 patients), MR growth patterns (expansive [28 patients] vs. mixed/infiltrative [31 patients]), recursive partitioning analysis (RPA) class, resection extent, and addition of chemotherapy. Primary outcome measure was survival.
  
  
  RESULTS
  Kaplan-Meier curves showed improved survival in NEAA, expansive tumors, and RPA 1 class patients. Within RPA class I patients, expansive growth pattern remained a significant advantage in survival time. Examining extent of resection also showed that patients with gross total resections (GTR) had a better prognosis. A multivariate (Cox proportional hazards) analysis showed that patient age and expansive tumor phenotype affected outcome, whereas RPA class, enhancement, and GTR did not.
  
  
  CONCLUSIONS
  Circumscribed growth in histologically proven anaplastic astrocytoma, which has not been emphasized in past studies, has a considerable survival advantage.
authors.affiliation: Department of Neurological Surgery, Thomas Jefferson University, 909 Walnut Street, Suite 200, Philadelphia, PA 19107, USA.
authors.forename: Hugh D
authors.initials: HD
authors.lastname: Moulding
authors.forename: David P
authors.initials: DP
authors.lastname: Friedman
authors.forename: Mark
authors.initials: M
authors.lastname: Curtis
authors.forename: Lawrence
authors.initials: L
authors.lastname: Kenyon
authors.forename: Adam E
authors.initials: AE
authors.lastname: Flanders
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
authors.forename: David W
authors.initials: DW
authors.lastname: Andrews
mesh_terms: D000328:Adult; D001254:Astrocytoma / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology* / Q000601:surgery; D016009:Chi-Square Distribution; D003287:Contrast Media; D003399:Craniotomy; D005260:Female; D019786:Gadolinium DTPA; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA