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Prognostic significance of CT contrast enhancement within histological subgroups of intracranial glioma

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Abstract

We report the prognostic significance of tumor CT contrast enhancement within histological subgroups in 831 consecutive adult glioma patients of high-grade (n=516) and low-grade (n=315) histology. In the present report, a negative prognostic factor is associated with shortened survival. Methods: Survival analysis including Kaplan-Meier plots, log-rank tests, Cox analysis, and Aalen's linear model as implemented in SPSS and S-PLUS. Results: Sensitivity and specificity of contrast enhancement as a test for high-grade glioma was 0.87 and 0.79, respectively. Enhancement was a strong negative prognostic factor comparable to high-grade histology in the total patient population. Enhancement was also a negative prognostic factor within the subgroups adult high-grade (Grade 3–4), anaplastic (Grade 3), and low-grade (Grade 1–2) gliomas (p < 0.001). The prognostic implications of initial enhancement declined in high-grade patients surviving beyond 36 months. Tumor contrast enhancement or calcifications (in parentheses) were present in 96% (3.6%) of glioblastomas, in 87% (7.4%) of high-grade gliomas, in 56.5% of anaplastic gliomas, and in 21% (16.2%) of low-grade gliomas. Calcification was a positive prognostic factor within the high-grade group of patients (p < 0.0001). Conclusion: Enhancement was a major prognostic factor comparable to high-grade histology in this glioma patient population. Enhancement was a negative prognostic factor within each of the adult subgroups high-grade, anaplastic (grade 3), and low-grade gliomas. Enhancement was strongly associated with but not pathognomonic for high-grade histology.

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References

  1. Byrne TN: Imaging of gliomas. Semin Oncol 21: 162–171, 1994

    Google Scholar 

  2. Macdonald DR: Low-grade gliomas, mixed gliomas, and oligodendrogliomas. Semin Oncol 21: 236–248, 1994

    Google Scholar 

  3. Silverman C, Marks JE: Prognostic significance of contrast enhancement in low grade astrocytomas of the adult cerebrum. Radiology 139: 211–213, 1981

    Google Scholar 

  4. Piepmeier JM: Observations on the current treatment of low-grade astrocytic tumors of the cerebral hemispheres. J Neurosurg 67: 177–810, 1987

    Google Scholar 

  5. Philippon JH, Clemenceau SH, Fauchon FH, Foncin JF: Supratentorial low-grade astrocytomas in adults. Neurosurgery 32: 554–559, 1993

    Google Scholar 

  6. Piepmeier J, Christopher S, Spencer D, Byrne T, Kim J, Kniscly J, Lacy J, Tsukerman L, Makuch R: Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 38: 872–878, 1996

    Google Scholar 

  7. Shibamoto Y, Kitakabu Y, Takahashi M, Yamashita J, Oda Y, Kikuchi H, Abe M: Supratentorial low-grade astrocytoma. Cancer 72: 190–195, 1993

    Google Scholar 

  8. Kreth FW, Faist M, Rossner R, Volk B, Ostertag CB: Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 79: 370–379, 1997

    Google Scholar 

  9. Daumas-Duport C, Tucker ML, Kolles H, Cervera P, Beuvon F, Varlet P, Udo N, Koziak M, Chodkiewicz JP: Oligodendrogliomas. Part II: a new grading system based on morphological and imaging criteria. J Neuro-Oncol 34: 61–78, 1997

    Google Scholar 

  10. McCormack BM, Miller DC, Budzilovich GN, Voorhees G, Ransohoff J: Treatment and survival of low-grade astrocytomas in adults 1977–1988. Neurosurgery 31: 636–642, 1992

    Google Scholar 

  11. Lete K, Egeland T, Hager B, Stenwig B, Skullerud K, Berg-Johnsen J, Storm-Mathisen I, Hirschberg H: Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 15: 3129–3140, 1997

    Google Scholar 

  12. Smith DF, Hutton JL, Sandemann D, Foy PM, Shaw MDM, Williams IR, Chadwick DW: The prognosis of primary intracerebral tumours presenting with epilepsy: the outcome of medical and surgical management. J Neurol Neurosurg Psychiatry 54: 915–920, 1991

    Google Scholar 

  13. Pierallini A, Bonamini M, Osti MF, Pantano P, Palmeggiani F, Santoro A, Maurizi Enrici R, Bozzao L: Supratentorial gliomblastoma: neuroradiological findings and survival after surgery and radiotherapy. Neuroradiology 38: S26–S30, 1996

    Google Scholar 

  14. Hutton JL, Smith DF, Sandemann D, Foy PM, Shaw MDM, Williams JR, Chadwick DW: Development of prognostic index for primary supratentorial intracerebral tumours. J Neurol Neurosurg Psychiatry 55: 271–274, 1992

    Google Scholar 

  15. Laws ER, Taylor WF, Clifton MB, Okazaki H: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61: 665–673, 1984

    Google Scholar 

  16. Westergaard L, Gjerris F, Klinken L: Prognostic parameters in benign astrocytomas. Acta Neurochir (Wien) 123: 1–7, 1993

    Google Scholar 

  17. Walker MD, Green SB, Byar DP, Alexander F, Jr, Batzdorf U, Brooks WH et al.: Randomized comparisons of radiotherapy and nitrosurcas for the treatment of malignant glioma after surgery. N Engl J Med 303: 1323–1329, 1980

    Google Scholar 

  18. World Health Organization: International classification of tumours No. 21 Histological typing of tumors of the central, nervous system, Geneva 1979

  19. WHO handbook for reporting results of cancer treatment. WHO Offset Publication No. 48. Geneva: World Health Organization, 1979

  20. SPSS Advanced Statistics 6.2. SPSS Inc. 1994, SPSS Inc. 444 N. Michigan Avenue, Chicago, Illinois 60611, USA

    Google Scholar 

  21. Collett P: Modelling survival in medical research. Chapman & Hall, New York 1994

    Google Scholar 

  22. Therneau TM, Grambsch PM, Fleming TR: Martingale-based residuals for survival models. Biometrika 77: 147–160, 1990

    Google Scholar 

  23. Aalen OO: A linear regression model for the analysis of life times. Statistics in Medicine 8: 907–925, 1989

    Google Scholar 

  24. Fekjær H, Aalen OO: Documentation for S-plus package for additive survival analysis. Unpublished manuscript available from University of Oslo, Section of Medical statistics, P.O. Box 1122 Blindern, Norway. (http://www.med.uio.no/imb/stat/addreg)

  25. Sox HC: Probability theory in the use of diagnostic tests. Ann Intern Med 104: 60–66, 1986

    Google Scholar 

  26. Vertosick FT Jr, Selker RG, Arena VC: Survival of patients with well-differentiated astrocytomas diagnosed in the era of computed tomography. Ncurosurgery 28: 496–501, 1991

    Google Scholar 

  27. Barker FG, Chang SM, Huhn SL, Davis RL, Gutin PH, McDermott MW, Wilson CB, Prados MD: Age and the risk of anaplasia in magnetic resonance-nonenhancing supratentorial cerebral tumors. Cancer 80: 936–941, 1997

    Google Scholar 

  28. Chamberlain MC, Murovic JA, Levin VA: Absence of contrast enhancement on CT brain scans of patients with supratentorial malignant gliomas. Neurology 38: 1371–1374, 1988

    Google Scholar 

  29. Kondziolka D, Lundsford LD, Martinez AJ: Unreliability of contemporary neurodiagnostic imaging in evaluating suspected adult supratentorial (low-grade) astrocytoma. J Neurosurg 79: 533–536, 1993

    Google Scholar 

  30. Butler AR, Horii SC, Kricheff H, Shannon MB, Budzilovich GN: Computed tomography in astrocytomas. Radiology 129: 433–439, 1978

    Google Scholar 

  31. Leeds NE, Elkin CM, Zimmermann RD: Gliomas of the brain. Semin Roentgenol 19: 27–43, 1984

    Google Scholar 

  32. Leighton C, Fisher B, Bauman G, Depiero S, Stitt L, Macdonald D, Cairneross G: Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 15: 1294–1301, 1997

    Google Scholar 

  33. MRC Brain Working Party: Prognostic factors for high-grade malignant glioma: development of a prognostic index. J Neuro-Oncol 9: 47–55, 1990

    Google Scholar 

  34. Soffictti R, Chio A, Giordana MT, Vasario E, Schiffer D: Prognostic factors in well-differentiated astrocytomas in the adult. Neurosurgery 24: 686–692, 1989

    Google Scholar 

  35. Roselli R, Iacoangeli M, Scerrati M, Rossi GF: Natural history of neuroepithelial tumours: contribution of stereotactic biopsy. Acta Neurochir Suppl 46: 79–81, 1989

    Google Scholar 

  36. Morantz RA: Radiation therapy in the treatment of cerebral astrocytoma. Neurosurgery 20: 975–982, 1987

    Google Scholar 

  37. Glantz MJ, Burger PC, Herndon JE, Friedman AH, Cairncross JG, Vich NA, Schold SC, Jr: Influence of the type of surgery on the histological diagnosis in patients with anaplastic gliomas. Neurology 41: 1741–1744, 1991

    Google Scholar 

  38. Daumas-Duport C, Varlet P, Tucker ML, Beuvon F, Cervera P, Chodkiewicz JP: Oligodendrogliomas. Part I: patterns of growth, histological diagnosis, clinical and imaging correlations: a study of 153 cases. J Neuro-Oncol 34: 37–59, 1997

    Google Scholar 

  39. Becker H, Vonofakos D: Diagnostic significance of brain calcifications in the computerized tomogram. Radiologe 23: 459–462, 1983

    Google Scholar 

  40. Mørk SJ, Lindegaard KF, Halvorsen TB, Lehmann EH, Solgaard T, Hatlevoll R, Harvei S, Ganz J: Oligodendroglioma: incidence and biological behavior in a defined population. J Neurosurgery 63: 881–889, 1985

    Google Scholar 

  41. Lee YY, VanTassel P: Intracranial oligodendrogliomas: imaging findings in 35 untreated cases. AJR 152: 361–369, 1989

    Google Scholar 

  42. Winger MJ, MacDonald DR, Cairneross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurgery 71: 487–493, 1989

    Google Scholar 

  43. Lee YY, VanTassel P, Bruner JM, Moser RP, Share JC: Juvenile pilocytic astrocytomas: CT and MR characteristics. AJR 152: 1263–1270, 1989

    Google Scholar 

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Authors and Affiliations

  1. Department of Oncology, Norwegian Radium Hospital, Oslo, Norway

    Knut Lote

  2. Department of Radiology, Norwegian Radium Hospital, Oslo, Norway

    Bjarne Hager

  3. Centre for Epidemiology and Hospital Statistics, National Hospital, Oslo, Norway

    Thore Egeland

  4. Department of Pathology, National Hospital, Oslo, Norway

    Kari Skullerud

  5. Department of Neurosurgery, National Hospital, Oslo, Norway

    Henry Hirschberg

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  1. Knut Lote
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  2. Thore Egeland
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  4. Kari Skullerud
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  5. Henry Hirschberg
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Lote, K., Egeland, T., Hager, B. et al. Prognostic significance of CT contrast enhancement within histological subgroups of intracranial glioma. J Neurooncol 40, 161–170 (1998). https://doi.org/10.1023/A:1006106708606

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