title: Stratification according to HGG-IMMUNO RPA model predicts outcome in a large group of patients with relapsed malignant glioma treated by adjuvant postoperative dendritic cell vaccination.
abstract: OBJECTIVE
  Adult patients with relapsed high-grade glioma are a very heterogenous group with, however, an invariably dismal prognosis. We stratified patients with relapsed high-grade glioma treated with re-operation and postoperative dendritic cell (DC) vaccination according to a simple recursive partitioning analysis (RPA) model to predict outcome.
  
  
  METHODS
  Based on age, pathology, Karnofsky performance score, and mental status, 117 adult patients with relapsed malignant glioma, undergoing re-operation, and postoperative adjuvant dendritic cell (DC) vaccination were stratified into 4 classes. Kaplan-Meier survival estimates were generated for each class of this HGG-IMMUNO RPA model. Extent of resection was documented but not included in the prognostic model.
  
  
  RESULTS
  Kaplan-Meier overall survival estimates revealed significant (p < 0.0001) differences among the 4 HGG-IMMUNO RPA classes. Long-term survivors, surviving more than 24 months after the re-operation and vaccination, are seen in 54.5, 26.7, 11.5, and 0 % for the classes I, II, III, and IV respectively.
  
  
  CONCLUSIONS
  This HGG-IMMUNO RPA classification is able to predict overall survival in a large group of adult patients with a relapsed malignant glioma, treated with re-operation and postoperative adjuvant DC vaccination in the HGG-IMMUNO-2003 cohort comparison trial. The model appears useful for prognostic patient counseling for patients participating in DC vaccination trials. A substantial number of long-term survivors after relapse are seen in class I to III, but not in class IV patients.
authors.affiliation: Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium. steven.devleeschouwer@uzleuven.be
authors.forename: Steven
authors.initials: S
authors.lastname: De Vleeschouwer
authors.forename: Hilko
authors.initials: H
authors.lastname: Ardon
authors.forename: Frank
authors.initials: F
authors.lastname: Van Calenbergh
authors.forename: Raf
authors.initials: R
authors.lastname: Sciot
authors.forename: Guido
authors.initials: G
authors.lastname: Wilms
authors.forename: Johannes
authors.initials: J
authors.lastname: van Loon
authors.forename: Jan
authors.initials: J
authors.lastname: Goffin
authors.forename: Stefaan
authors.initials: S
authors.lastname: Van Gool
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D019496:Cancer Vaccines / Q000276:immunology / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003713:Dendritic Cells / Q000276:immunology / Q000637:transplantation*; D005260:Female; D005910:Glioma / Q000145:classification* / Q000601:surgery / Q000628:therapy; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery / Q000628:therapy; D011184:Postoperative Period; D011379:Prognosis; D012086:Reoperation; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000276:Adjuvants, Immunologic; D019496:Cancer Vaccines