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Prognostic factors in pediatric high-grade astrocytoma: the importance of accurate pathologic diagnosis

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Abstract

To characterize a population of pediatric high-grade astrocytoma (HGA) patients by confirming the proportion with a correct diagnosis, and determine prognostic factors for survival in a subset diagnosed with uniform pathologic criteria. Sixty-three children diagnosed with HGA were treated at the Johns Hopkins Hospital between 1977 and 2004. A single neuropathologist (P.C.B.) reviewed all available histologic samples (n = 48). Log-rank analysis was used to compare survival by patient, tumor, and treatment factors. Median follow-up was 16 months for all patients and 155 months (minimum 54 months) for surviving patients. Median survival for all patients (n = 63) was 14 months with 10 long-term survivors (survival >48 months). At initial diagnosis, 27 patients were grade III (43%) and 36 grade IV (57%). Forty-eight patients had pathology slides available for review, including seven of ten long-term surviving patients. Four patients had non-HGA pathology, all of whom were long term survivors. The remaining 44 patients with confirmed HGG had a median survival of 14 months and prognostic analysis was confined to these patients. On multivariate analysis, five factors were associated with inferior survival: performance status (Lansky) <80% (13 vs. 15 months), bilaterality (13 vs. 19 months), parietal lobe location (13 vs. 16 months), resection less than gross total (13 vs. 22 months), and radiotherapy dose <50 Gy (9 vs. 16 months). Among patients with more than one of the five adverse factors (n = 27), median survival and proportion of long-term survivors were 12.9 months and 0%, compared with 41.4 months and 18% for patients with 0–1 adverse factors (n = 17). In an historical cohort of children with HGA, the potential for long term survival was confined to the subset with less than two of the following adverse prognostic factors: low performance status, bilaterality, parietal lobe site, less than gross total resection, and radiotherapy dose <50 Gy. Pathologic misdiagnosis should be suspected in patients who are long term survivors of a pediatric high grade astrocytoma.

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Acknowledgements

Kaisorn Chaichana was supported by the American Brain Tumor Association Fellowship for medical students. Portions of this work were supported by the Children’s Cancer Foundation. We acknowledge the Johns Hopkins Tumor Registry as well as Patricia Goldthwaite for assistance with data collection.

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Authors and Affiliations

  1. Department of Radiation Oncology and Molecular Radiation Sciences, The Johns Hopkins University School of Medicine, 401 North Broadway, Suite 1440, Baltimore, MD, 21231, USA

    Russell K. Hales, Danny Y. Song & Moody D. Wharam

  2. Department of Radiation Oncology, York Cancer Center, 25 Monument Road, Suite 94, York, PA, 17403, USA

    Ori Shokek

  3. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Peter C. Burger

  4. Division of Preventive Medicine, Brigham and Women’s Hospital, 900 Commonwealth Ave., Boston, MA, 02215, USA

    Nina P. Paynter

  5. Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kaisorn L. Chaichana, Alfredo Quiñones-Hinojosa, George I. Jallo & Benjamin S. Carson

  6. Department of Oncology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Kenneth J. Cohen

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  1. Russell K. Hales
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Correspondence to Moody D. Wharam.

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Presented at: International Society of Paediatric Oncology, 2006 and American Society for Therapeutic Radiology and Oncology, 2007.

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Hales, R.K., Shokek, O., Burger, P.C. et al. Prognostic factors in pediatric high-grade astrocytoma: the importance of accurate pathologic diagnosis. J Neurooncol 99, 65–71 (2010). https://doi.org/10.1007/s11060-009-0102-3

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  • DOI: https://doi.org/10.1007/s11060-009-0102-3

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