title: Clinical and prognostic features of adult patients with gangliogliomas.
abstract: BACKGROUND
  Gangliogliomas (GGs) represent <1% of primary brain tumors in adults. Little is known regarding prognostic features, clinical characteristics, or the impact of treatment on patient outcomes.
  
  
  METHODS
  Our neuro-oncology longitudinal database was screened for patients with GG from 1992 to 2012. Sixty-seven patients (age >18 y) were identified.
  
  
  RESULTS
  Sixty-two patients presented with low-grade GG and 5 with anaplastic GG. The median age at diagnosis was 29 years. With a median follow-up of 4.7 years after the initial diagnosis, 23 patients had progressive disease. Range of time to progression was 0.2-20 years. Nine patients with low-grade GG progressed to a malignant tumor. The median overall survival (OS) for all patients was not reached. The 2-, 5-, and 10-year OS for patients with low-grade GG were 100%, 88% (95% confidence interval [CI]: 73%, 95%), and 84% (95% CI: 67%, 93%), respectively. Factors identified by univariate analysis that were significantly associated with OS were age, KPS, extent of resection (EOR), and grade. Factors on univariate analysis that were significantly associated with progression-free survival were grade and EOR. On multicovariate Cox regression, lower tumor grade and younger age were significant factors for longer OS. EOR is a significant factor for progression-free survival.
  
  
  CONCLUSIONS
  While GG has excellent prognosis, malignant histologic grade, older age, and diagnosis with biopsy could indicate worse prognosis. The late nature and high rate of progression emphasize the importance of long-term follow-up. The role of chemotherapy and radiation therapy for incompletely resected low-grade GG remains unclear.
authors.affiliation: Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.Y.-K., D.L., J.F.de-G.); Department of Neurology, The University of Mississippi Medical Center, Jackson, Mississippi (M.D.A.); Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas (J.W., Y.Y.); Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas (A.O., G.N.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (P.D.B.).
authors.forename: Shlomit
authors.initials: S
authors.lastname: Yust-Katz
authors.forename: Mark Daniel
authors.initials: MD
authors.lastname: Anderson
authors.forename: Diane
authors.initials: D
authors.lastname: Liu
authors.forename: Jimin
authors.initials: J
authors.lastname: Wu
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.forename: Adriana
authors.initials: A
authors.lastname: Olar
authors.forename: Greg N
authors.initials: GN
authors.lastname: Fuller
authors.forename: Paul D
authors.initials: PD
authors.lastname: Brown
authors.forename: John F
authors.initials: JF
authors.lastname: de-Groot
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality; D005260:Female; D018303:Ganglioglioma / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
keywords: adults; ganglioglioma; malignant transformation; progression; treatment