Clinicopathologic study of 85 similarly treated patients with anaplastic astrocytic tumors - An analysis of DNA content (ploidy), cellular proliferation, and p53 expression

BACKGROUND. The biologic behavior of anaplastic (World Health Organization Grade III) astrocytomas and oligoastrocytomas is highly variable, ranging f rom rapid progression to prolonged survival. It is difficult to predict the outcome of an individual patient based on morphology alone. METHODS. To determine the prognostic value of commonly used clinicopatholog ic markers, we reviewed our experience with 85 similarly treated patients e nrolled in 3 North Central Cancer Treatment Group high grade glioma protoco ls. The pathology was comprised exclusively of primary anaplastic astrocyti c tumors (66 astrocytomas and 19 oligoastrocytomas). Variables examined inc luded patient age, morphologic type, preoperative performance score, extent of surgery, solitary versus multiple mitoses, DNA flow cytometric and imag e morphometric parameters, and expression of proliferating cell nuclear ant igen, MIB-1, and p53 expression. RESULTS. The study was comprised of 48 men and 37 women ranging in age from 14-79 years (median age, 47 years). Overall survival ranged from <1 month to >12 years (median, 21.6 months). Statistical analyses revealed that age accounted for the majority of this extensive variability in survival. The m edian survival rimes were 65.5 months, 22.1 months, and 4.4 months, respect ively, for the groups <40 years, 40-59 years, and greater than or equal to 60 years, respectively (P < 0.0001). On univariate analyses, aneuploidy by flow cytometry and a low performance score also predicted a better survival (P values of 0.04 and 0.009, respectively). Statistical trends predicting a better survival were observed for patients with a solitary mitosis and p5 3 immunopositivity. However, only patient age remained significant in multi variate models. CONCLUSIONS. In a small but relatively uniformly treated cohort of patients with anaplastic astrocytomas and oligoastrocytomas, patient age was associ ated strongly and inversely with overall survival. Once patient age was tak en into account, the clinical and pathologic markers tested appeared to be of limited prognostic value. Cancer 1999;86:672-83, (C) 1999 American Cance r Society.