Impact of histopathological transformation and overall survival in patients with progressive anaplastic glioma.
Progression of anaplastic glioma (World Health Organization [WHO] grade III) is typically determined radiographically, and transformation to glioblastoma (GB) (WHO grade IV) is often presumed at that time. However, the frequency of actual histopathologic transformation of anaplastic glioma and the subsequent clinical impact is unclear. To determine these associations, we retrospectively reviewed all anaplastic glioma patients who underwent surgery at our center at first radiographic progression, and we examined the effects of histological diagnosis, clinical history, and molecular factors on transformation rate and survival. We identified 85 anaplastic glioma (39 astrocytoma, 24 oligodendroglioma, 22 oligoastrocytoma), of which 38.8% transformed to GB. Transformation was associated with shorter overall survival (OS) from the time of diagnosis (3.4 vs. 10.9years, p=0.0005) and second surgery (1.0 vs. 3.5years, p<0.0001). Original histologic subtype did not significantly impact the risk of transformation or OS. No other factors, including surgery, adjuvant therapy or molecular markers, significantly affected the risk of transformation. However, mutations in isocitrate dehydrogenase 1 (IDH1) was associated with longer time to progression (median 4.6 vs. 1.4years, p=0.008) and OS (median 10.0 vs. 4.2years, p=0.046). At radiographic progression, tissue diagnosis may be warranted as histologic grade may provide valuable prognostic information and affect therapeutic clinical trial selection criteria for this patient population.
Department of Neurosurgery, Stanford University, Palo Alto, CA, USA.
Allen L
AL
Ho
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Matthew J
MJ
Koch
University of Tokyo Hospital, Tokyo, Japan.
Shota
S
Tanaka
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
April F
AF
Eichler
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Tracy T
TT
Batchelor
Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
Jantima
J
Tanboon
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA; Department of Pathology, Massachusetts General Hospital, Boston, MA, USA.
David N
DN
Louis
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
Daniel P
DP
Cahill
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA.
Andrew S
AS
Chi
Stephen E. and Catherine Pappas Center for Neuro-Oncology and Division of Hematology/Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, 55 Fruit Street/Y9E, Boston, MA 02114, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA. Electronic address: wcurry@mgh.harvard.edu.
William T
WT
Curry
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D002471:Cell Transformation, Neoplastic / Q000473:pathology*; D003131:Combined Modality Therapy; D018450:Disease Progression; D005260:Female; D005910:Glioma / Q000235:genetics / Q000401:mortality / Q000473:pathology*; D006801:Humans; D007521:Isocitrate Dehydrogenase / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011379:Prognosis; D012189:Retrospective Studies
D007521:Isocitrate Dehydrogenase
Anaplastic glioma; Glioblastoma; Malignant glioma; Recurrent glioma; Transformation