title: Glioma vascularity correlates with reduced patient survival and increased malignancy.
abstract: BACKGROUND
  The objective of this study was 2-fold: (1) document the presence and degree of vascularity in gliomas of different pathologic grades and (2) determine whether the presence of abnormal vascularity, determined by catheter angiography, correlates with a shortened survival.
  
  
  METHODS
  As part of a protocol for radiographic data acquisition that was used in a computer-assisted, stereotactic system, all patients who underwent biopsy or resection of a newly diagnosed glioma between 1994 and 2000 at our institution routinely underwent preoperative catheter angiography. The presence and degree of tumor vascularity were recorded and then correlated with survival and pathologic grade. The confounding effects of age, KPS, adjuvant treatment, and extent of resection on survival were considered.
  
  
  RESULTS
  Two hundred thirty-one patients were included in this study. The mean follow-up of survivors was 7.8 years. Tumor vascularity correlated with a shortened survival (proportional hazards RR for survival, 0.69; 95% CI, 0.58-0.82). This correlation persisted after correction for age, KPS score, adjuvant therapy, and extent of resection (RR, 0.81; 95% CI, 0.68-0.97). Abnormal vascularity was present in 25 (30%) of 82 low-grade (WHO grade 2) gliomas. Overall, the extent of vascularity (none [120 patients, 52%], blush [63 patients, 27%], neovessels [25 patients, 11%], and arteriovenous shunting [23 patients, 10%]) correlated with worse WHO tumor grade (P < .0001).
  
  
  CONCLUSIONS
  The presence of abnormal vascularity correlates with both a shortened survival and higher grade of malignancy. These findings underscore the importance of antiangiogenesis factor investigation and drug development for the treatment of gliomas, regardless of their pathologic grade.
authors.affiliation: Department of Neurosurgery, New York University School of Medicine, New York, NY 10016, USA. russes01@yahoo.com
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Russell
authors.forename: Robert
authors.initials: R
authors.lastname: Elliott
authors.forename: David
authors.initials: D
authors.lastname: Forshaw
authors.forename: John G
authors.initials: JG
authors.lastname: Golfinos
authors.forename: Peter K
authors.initials: PK
authors.lastname: Nelson
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Kelly