A COMPARISON OF THE PREDICTIVE POWER FOR SURVIVAL IN GLIOMAS PROVIDEDBY MIB-1, BROMODEOXYURIDINE AND PROLIFERATING CELL NUCLEAR ANTIGEN WITH HISTOPATHOLOGIC AND CLINICAL-PARAMETERS

The purpose of this prospective study of 65 patients was to compare si de-by-side the predictive power for survival of (a) MIB-1, (b) bromode oxyuridine (BUDR), and (c) proliferating cell nuclear antigen (PCNA). They were compared (a) with each other. (b) with several clinical pred ictors, and (c) with histopathologic grade under actual clinical biops y conditions in a study of 1993 World Wealth Organization (WHO) grade II to IV adult supratentorial gliomas. There was a strong positive rel ationship between MIB-1 and BUDR by Spearman Rank correlation. In univ ariate analysis, MIB-1 (logrank p = 0.06) was more predictive of survi val than BUDR or PCNA. Longer survivors were distinguished from others by the lowest MIB-1 labeling indices (LI less than or equal to 2.5%) better than by the lowest histopathologic grade. However, histopatholo gic grades were highly predictive among the entire group (logrank p < 0.0001). Young age (p < 0.0001) and high Karnofsky performance status (p < 0.0001) were the clinical factors most predictive of longer survi val. Female gender correlated with longer survival (logrank p = 0.02). In multivariate Cox proportional hazards models, age, Karnofsky perfo rmance status. and histopathologic grading remained statistically sign ificant after full reduction of the model. We conclude that Ki-67 meas ured by MIB-1 monoclonal antibody was superior to other markers of pro liferation. When all factors are considered simultaneously over all 3 grades of malignancy, greatest predictive power resides in histopathol ogic grade and clinical variables. MLB-1 is expected to be most import ant in eases where clinical or histopathologic factors are ambiguous o r where they cannot be fully assessed.