PROGNOSTIC FACTORS IN SUPRATENTORIAL WHO-GRADE-II ASTROCYTOMA IN ADULTS

The records of 33 adult patients with supratentorial World Health Orga nization grade II astrocytoma (A-II) treated between January 1980 and April 1997 at our hospitals were retrospectively reviewed. All tumours were surgically resected or biopsied and their MIB-1 labelling indice s (LIs) were less than 1.5%. The median time to tumour progression aft er the initial surgery was 60 months, and the 5- and 10-year tumour pr ogression-free rates were 53 and 39%, respectively. The median surviva l time was 107 months, and the 5- and 10-year survival rates were 66 a nd 43%, respectively. The major cause of death was tumour recurrence w ith malignant transformation, comprising 93% of all deaths due to unre strained tumour growth. In a univariate analysis for survival rate by log-rank test, age (< 60 years), Kamofsky Performance Scale score (90- 100%), tumour location (except for the basal ganglia), and extent of s urgery (more than biopsy) were revealed to be significant positive pro gnostic factors. A Cox proportional hazard multivariate regression ana lysis confirmed that the age was the only independent, significant pos itive prognostic factor in this series. The survival time after the in itial surgery in patients without radiotherapy tended to be prolonged compared with those of the patients with radiotherapy. Of the 26 patie nts who received radiotherapy, however, the survival time after the in itial surgery in the nine patients with intraoperative radiotherapy wa s significantly prolonged compared with the 17 patients who received s ole external beam radiotherapy. Gender, symptoms, histology, p53 LI, e nhancement on CT/MRI, cyst, calcification and chemotherapy were not sh own to be significant prognostic factors. The optimal management strat egy for A-II is expected to be established by clarification of the nat ural history with cytological and molecular biological analyses of the biological features of this disease.