The influence of sex and the presence of giant cells on postoperative long-term survival in adult patients with supratentorial glioblastoma multiforme

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Object. Glioblastoma multiforme (GBM) remains incurable by conventional treatments, although some patients experience long-term survival. A younger age, a higher Karnofsky Performance Scale (KPS) score, more aggressive treatment, and long progression-free intervals have been reported to be positively associated with long-term postoperative patient survival. The aim of this retrospective study was the identification of additional favorable prognostic factors affecting long-term survival in surgically treated adult patients with supratentorial GBM.

Methods. Of 113 adult patients newly diagnosed with histologically verified supratentorial GBM who were enrolled in Phase III trials during the period between 1987 and 1998, six (5.3%) who survived for longer than 5 years were defined as long-term survivors, whereas the remaining 107 patients served as controls. All six were women and were compared with the controls; they were younger (mean age 44.2 years, range 31–60 years), and their preoperative KPS scores were higher (mean 85, range 60–100). Four of the six patients underwent gross-total resection. In five patients (83.3%) the progression-free interval was longer than 5 years and in three a histopathological diagnosis of giant cell GBM was made. This diagnosis was not made in the other 107 patients.

Conclusions. Among adult patients with supratentorial GBM, female sex and histopathological characteristics consistent with giant cell GBM may be predictive of a better survival rate, as may traditional factors (that is, younger age, good KPS score, more aggressive resection, and a long progression-free interval).

Article Information

Address reprint requests to: Naoki Shinojima, M.D., Department of Neurosurgery, Arao City Hospital, 2600 Arao, Kumamoto 864–0041, Japan. email: shinojima@rio.odn.ne.jp.

© AANS, except where prohibited by US copyright law.

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Figures

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    Contrast-enhanced CT and MR images. A–C: Case 3. Note the irregularly shaped ringlike enhanced mass lesion with peritumoral edema on this preoperative image (A). Following gross-total resection an area of hyperintensity at the bottom of the resection cavity is a local postoperative change (B). Six years after gross-total resection there is a marked brain cortical atrophy (C). D–F: Case 4. The left frontal tumor (D) was totally resected (E). Enhanced lesions in the right frontal lobe were visualized 7.5 years later (F) and tumor recurrence was confirmed by biopsy. G–I: Case 6. The left frontal tumor (G) was totally removed (H), and there was no sign of tumor recurrence 5 years later (I).

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    Photomicrographs showing tumor specimens from Case 3 (A and B), Case 4 (C and D), and Case 6 (E and F). In each case large areas of necrosis and microvascular proliferation (A, C, and E) and marked pleomorphic nuclei (B, D, and F) were identified. In Case 4 there were many areas of pseudopalisading necrosis (C). Numerous giant cells with extremely unusual mono- or multinuclei were found in each case (B, D, and F). H & E, original magnifications × 50 (A, C, and E) and × 200 (B, D, and F).

References

1.

Akslen LAMork SJLarsen JLet al: Giant cell glioblastoma: a work-up of 2 cases with long survival. Acta Neurol Scand 79:1941991989Akslen LA Mork SJ Larsen JL et al: Giant cell glioblastoma: a work-up of 2 cases with long survival. Acta Neurol Scand 79:194–199 1989

2.

Albert FKForsting MSartor Ket al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45611994Albert FK Forsting M Sartor K et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45–61 1994

3.

Archibald YMLunn DRuttan LAet al: Cognitive functioning in long-term survivors of high-grade glioma. J Neurosurg 80:2472531994Archibald YM Lunn D Ruttan LA et al: Cognitive functioning in long-term survivors of high-grade glioma. J Neurosurg 80:247–253 1994

4.

Bauman GSIno YUeki Ket al: Allelic loss of chromosome 1p and radiotherapy plus chemotherapy in patients with oligodendrogliomas. Int J Radiat Oncol Biol Phys 48:8258302000Bauman GS Ino Y Ueki K et al: Allelic loss of chromosome 1p and radiotherapy plus chemotherapy in patients with oligodendrogliomas. Int J Radiat Oncol Biol Phys 48:825–830 2000

5.

Bouchard JPeirce CB: Radiation therapy in the management of neoplasms of the central nervous system, with a special note in regard to children: Twenty years' experience, 1939–1958. AJR Rad Ther Nucl Med 84:6106281960Bouchard J Peirce CB: Radiation therapy in the management of neoplasms of the central nervous system with a special note in regard to children: Twenty years' experience 1939–1958. AJR Rad Ther Nucl Med 84:610–628 1960

6.

Bucy PCOberhill HRSiqueira EBet al: Cerebral glioblastomas can be cured! Neurosurgery 16:7147171985Bucy PC Oberhill HR Siqueira EB et al: Cerebral glioblastomas can be cured! Neurosurgery 16:714–717 1985

7.

Burger PCVollmer RT: Histologic factors of prognostic significance in the glioblastoma multiforme. Cancer 46:117911861980Burger PC Vollmer RT: Histologic factors of prognostic significance in the glioblastoma multiforme. Cancer 46:1179–1186 1980

8.

Burton ECLamborn KRForsyth Pet al: Aberrant p53, mdm2, and proliferation differ in glioblastomas from long-term compared with typical survivors. Clin Cancer Res 8:1801872002Burton EC Lamborn KR Forsyth P et al: Aberrant p53 mdm2 and proliferation differ in glioblastomas from long-term compared with typical survivors. Clin Cancer Res 8:180–187 2002

9.

Cairncross JGUeki KZlatescu MCet al: Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:147314791998Cairncross JG Ueki K Zlatescu MC et al: Specific genetic predictors of chemotherapeutic response and survival in patients with anaplastic oligodendrogliomas. J Natl Cancer Inst 90:1473–1479 1998

10.

Cervoni LCelli PSalvati M: Long-term survival in a patient with supratentorial glioblastoma: clinical considerations. Ital J Neurol Sci 19:2212241998Cervoni L Celli P Salvati M: Long-term survival in a patient with supratentorial glioblastoma: clinical considerations. Ital J Neurol Sci 19:221–224 1998

11.

Chandler KLPrados MDMalec Met al: Long-term survival in patients with glioblastoma multiforme. Neurosurgery 32:7167201993Chandler KL Prados MD Malec M et al: Long-term survival in patients with glioblastoma multiforme. Neurosurgery 32:716–720 1993

12.

Dara PSlater LMTalreja Det al: Long-term survivors of high-grade malignant astrocytomas. Med Pediatr Oncol 8:1871911980Dara P Slater LM Talreja D et al: Long-term survivors of high-grade malignant astrocytomas. Med Pediatr Oncol 8:187–191 1980

13.

Davis FGFreels SGrutsch Jet al: Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology, and End Results (SEER) data, 1973–1991. J Neurosurg 88:1101998Davis FG Freels S Grutsch J et al: Survival rates in patients with primary malignant brain tumors stratified by patient age and tumor histological type: an analysis based on Surveillance Epidemiology and End Results (SEER) data 1973–1991. J Neurosurg 88:1–10 1998

14.

Elvidge ARBarone BM: Long-term postoperative survival in two cases of glioblastoma multiforme. J Neurosurg 22:3823861965Elvidge AR Barone BM: Long-term postoperative survival in two cases of glioblastoma multiforme. J Neurosurg 22:382–386 1965

15.

Gullotta FBettag W: Zür Frage der längeren Überlebenszeit bei Glioblastomen. Acta Neurochir 16:1221281967Gullotta F Bettag W: Zür Frage der längeren Überlebenszeit bei Glioblastomen. Acta Neurochir 16:122–128 1967

16.

Hatanaka HSano KKitamura Ket al: CT findings in patients with gliomas surviving more than 10 years. Neurochirurgia 27:1061101984Hatanaka H Sano K Kitamura K et al: CT findings in patients with gliomas surviving more than 10 years. Neurochirurgia 27:106–110 1984

17.

Hiesiger EMHayes RLPierz DMet al: Prognostic relevance of epidermal growth factor receptor (EGF-R) and c-neu/erbB2 expression in glioblastomas (GBMs). J Neurooncol 16:931041993Hiesiger EM Hayes RL Pierz DM et al: Prognostic relevance of epidermal growth factor receptor (EGF-R) and c-neu/erbB2 expression in glioblastomas (GBMs). J Neurooncol 16:93–104 1993

18.

Hirano HAsakura TYokoyama Set al: [The prognostic factors in astrocytic tumors: analysis by the Kaplan—Meier method and the Weibull log-linear model.] No Shinkei Geka 24:8098151996 (Jpn)Hirano H Asakura T Yokoyama S et al: [The prognostic factors in astrocytic tumors: analysis by the Kaplan—Meier method and the Weibull log-linear model.] No Shinkei Geka 24:809–815 1996 (Jpn)

19.

Huang MCKubo OTajika Yet al: A clinico-immunohistochemical study of giant cell glioblastoma. Noshuyo Byori 13:11161996Huang MC Kubo O Tajika Y et al: A clinico-immunohistochemical study of giant cell glioblastoma. Noshuyo Byori 13:11–16 1996

20.

Imperato JPPaleologos NAVick NA: Effects of treatment on long-term survivors with malignant astrocytomas. Ann Neurol 28:8188221990Imperato JP Paleologos NA Vick NA: Effects of treatment on long-term survivors with malignant astrocytomas. Ann Neurol 28:818–822 1990

21.

Ishikura AIkeda MKogure Yet al: [A giant cell glioblastoma—a case report.] Gan No Rinsho 35:2932971989 (Jpn)Ishikura A Ikeda M Kogure Y et al: [A giant cell glioblastoma—a case report.] Gan No Rinsho 35:293–297 1989 (Jpn)

22.

Jelsma RBucy PC: The treatment of glioblastoma multiforme of the brain. J Neurosurg 27:3884001967Jelsma R Bucy PC: The treatment of glioblastoma multiforme of the brain. J Neurosurg 27:388–400 1967

23.

Johnson AC: Malignant intracranial tumor: report of three cases with long-term postoperative survival. Surg Neurol 15:2172191981Johnson AC: Malignant intracranial tumor: report of three cases with long-term postoperative survival. Surg Neurol 15:217–219 1981

24.

Kallio MSankila RJaaskelainen Jet al: A population-based study on the incidence and survival rates of 3857 glioma patients diagnosed from 1953 to 1984. Cancer 68:139414001991Kallio M Sankila R Jaaskelainen J et al: A population-based study on the incidence and survival rates of 3857 glioma patients diagnosed from 1953 to 1984. Cancer 68:1394–1400 1991

25.

Kleihues PBurger PCScheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:2552681993Kleihues P Burger PC Scheithauer BW: The new WHO classification of brain tumours. Brain Pathol 3:255–268 1993

26.

Kleihues PCavenee WK: Pathology and Genetics of Tumours of the Nervous System. IARC Scientific. Lyon, France: IARC2000Kleihues P Cavenee WK: Pathology and Genetics of Tumours of the Nervous System. IARC Scientific. Lyon France: IARC 2000

27.

Klein RMolenkamp GSorensen Net al: Favorable outcome of giant cell glioblastoma in a child. Report of an 11-year survival period. Childs Nerv Syst 14:2882911998Klein R Molenkamp G Sorensen N et al: Favorable outcome of giant cell glioblastoma in a child. Report of an 11-year survival period. Childs Nerv Syst 14:288–291 1998

28.

Kochii MKitamura IGoto Tet al: Randomized comparison of intra-arterial versus intravenous infusion of ACNU for newly diagnosed patients with glioblastoma. J Neurooncol 49:63702000Kochii M Kitamura I Goto T et al: Randomized comparison of intra-arterial versus intravenous infusion of ACNU for newly diagnosed patients with glioblastoma. J Neurooncol 49:63–70 2000

29.

Kraus JAWenghoefer MSchmidt MCet al: Long-term survival of glioblastoma multiforme: importance of histopathological reevaluation. J Neurol 247:4554602000Kraus JA Wenghoefer M Schmidt MC et al: Long-term survival of glioblastoma multiforme: importance of histopathological reevaluation. J Neurol 247:455–460 2000

30.

Ley ALey A JrGuitart JMet al: Surgical management of intracranial gliomas. J Neurosurg 19:3653741962Ley A Ley A Jr Guitart JM et al: Surgical management of intracranial gliomas. J Neurosurg 19:365–374 1962

31.

Margetts JCKalyan-Raman UP: Giant-celled glioblastoma of brain. A clinico-pathological and radiological study of ten cases (including immunohistochemistry and ultrastructure). Cancer 63:5245311989Margetts JC Kalyan-Raman UP: Giant-celled glioblastoma of brain. A clinico-pathological and radiological study of ten cases (including immunohistochemistry and ultrastructure). Cancer 63:524–531 1989

32.

Morita MRosenblum MKBilsky MHet al: Long-term survivors of glioblastoma multiforme: clinical and molecular characteristics. J Neurooncol 27:2592661996Morita M Rosenblum MK Bilsky MH et al: Long-term survivors of glioblastoma multiforme: clinical and molecular characteristics. J Neurooncol 27:259–266 1996

33.

Muller HBrock MErnst H: Long-term survival and recurrencefree interval in combined surgical, radio- and chemotherapy of malignant brain gliomas. Clin Neurol Neurosurg 87:1671711985Muller H Brock M Ernst H: Long-term survival and recurrencefree interval in combined surgical radio- and chemotherapy of malignant brain gliomas. Clin Neurol Neurosurg 87:167–171 1985

34.

Netsky MGAugust BFowler W: The longevity of patients with glioblastoma multiforme. J Neurosurg 7:2612691950Netsky MG August B Fowler W: The longevity of patients with glioblastoma multiforme. J Neurosurg 7:261–269 1950

35.

New PVokes ERogers Let al: Long-term response to crisnatol mesylate in patients with glioma. Invest New Drugs 15:3433521997New P Vokes E Rogers L et al: Long-term response to crisnatol mesylate in patients with glioma. Invest New Drugs 15:343–352 1997

36.

Nomura K: [Current status of treatment of brain tumors in Japan: from the report of brain tumor registry of Japan.] No To Shinkei 53:4444522001 (Jpn)Nomura K: [Current status of treatment of brain tumors in Japan: from the report of brain tumor registry of Japan.] No To Shinkei 53:444–452 2001 (Jpn)

37.

Palma LCelli PMaleci Aet al: Malignant monstrocellular brain tumours. A study of 42 surgically treated cases. Acta Neurochir 97:17251989Palma L Celli P Maleci A et al: Malignant monstrocellular brain tumours. A study of 42 surgically treated cases. Acta Neurochir 97:17–25 1989

38.

Phuphanich SFerrall SGreenberg H: Long-term survival in malignant glioma. Prognostic factors. J Fla Med Assoc 80:1811841993Phuphanich S Ferrall S Greenberg H: Long-term survival in malignant glioma. Prognostic factors. J Fla Med Assoc 80:181–184 1993

39.

Plunkett RJLis ABarone TAet al: Hormonal effects on glioblastoma multiforme in the nude rat model. J Neurosurg 90:107210771999Plunkett RJ Lis A Barone TA et al: Hormonal effects on glioblastoma multiforme in the nude rat model. J Neurosurg 90:1072–1077 1999

40.

Pollak LGur RWalach Net al: Clinical determinants of long-term survival in patients with glioblastoma multiforme. Tumori 83:6136171997Pollak L Gur R Walach N et al: Clinical determinants of long-term survival in patients with glioblastoma multiforme. Tumori 83:613–617 1997

41.

Puzzilli FRuggeri AMastronardi Let al: Long-term survival in cerebral glioblastoma. Case report and critical review of the literature. Tumori 84:69741998Puzzilli F Ruggeri A Mastronardi L et al: Long-term survival in cerebral glioblastoma. Case report and critical review of the literature. Tumori 84:69–74 1998

42.

Roth JGElvidge AR: Glioblastoma multiforme: a clinical survey. J Neurosurg 17:7367501960Roth JG Elvidge AR: Glioblastoma multiforme: a clinical survey. J Neurosurg 17:736–750 1960

43.

Rutz HPde Tribolet NCalmes JMet al: Long-time survival of a patient with glioblastoma and Turcot's syndrome. Case report. J Neurosurg 74:8138151991Rutz HP de Tribolet N Calmes JM et al: Long-time survival of a patient with glioblastoma and Turcot's syndrome. Case report. J Neurosurg 74:813–815 1991

44.

Sabel MReifenberger JWeber RGet al: Long-term survival of a patient with giant cell glioblastoma. Case report. J Neurosurg 94:6056112001Sabel M Reifenberger J Weber RG et al: Long-term survival of a patient with giant cell glioblastoma. Case report. J Neurosurg 94:605–611 2001

45.

Salcman MScholtz HKaplan RSLong-term survival in patients with malignant astrocytoma. Neurosurgery 34:2132201994Salcman M Scholtz H Kaplan RS Long-term survival in patients with malignant astrocytoma. Neurosurgery 34:213–220 1994

46.

Salford LGBrun ANirfalk S: Ten-year survival among patients with supratentorial astrocytomas grade III and IV. J Neurosurg 69:5065091988Salford LG Brun A Nirfalk S: Ten-year survival among patients with supratentorial astrocytomas grade III and IV. J Neurosurg 69:506–509 1988

47.

Salvati MCervoni LArtico Met al: Long-term survival in patients with supratentorial glioblastoma. J Neurooncol 36:61641998Salvati M Cervoni L Artico M et al: Long-term survival in patients with supratentorial glioblastoma. J Neurooncol 36:61–64 1998

48.

Sant Mvan der Sanden GCapocaccia R: Survival rates for primary malignant brain tumours in Europe. Eur J Cancer 34:224122471998Sant M van der Sanden G Capocaccia R: Survival rates for primary malignant brain tumours in Europe. Eur J Cancer 34:2241–2247 1998

49.

Scott JNRewcastle NBBrasher PMet al: Long-term glioblastoma multiforme survivors: a population-based study. Can J Neurol Sci 25:1972011998Scott JN Rewcastle NB Brasher PM et al: Long-term glioblastoma multiforme survivors: a population-based study. Can J Neurol Sci 25:197–201 1998

50.

Scott JNRewcastle NBBrasher PMet al: Which glioblastoma multiforme patient will become a long-term survivor? A population-based study. Ann Neurol 46:1831881999Scott JN Rewcastle NB Brasher PM et al: Which glioblastoma multiforme patient will become a long-term survivor? A population-based study. Ann Neurol 46:183–188 1999

51.

Seki YSuico MAUto Aet al: The ETS transcription factor MEF is a candidate tumor suppressor gene on the X chromosome. Cancer Res 62:657965862002Seki Y Suico MA Uto A et al: The ETS transcription factor MEF is a candidate tumor suppressor gene on the X chromosome. Cancer Res 62:6579–6586 2002

52.

Shibamoto YYamashita JTakahashi Met al: Supratentorial malignant glioma: an analysis of radiation therapy in 178 cases. Radiother Oncol 18:9171990Shibamoto Y Yamashita J Takahashi M et al: Supratentorial malignant glioma: an analysis of radiation therapy in 178 cases. Radiother Oncol 18:9–17 1990

53.

Surawicz TSDavis FFreels Set al: Brain tumor survival: results from the National Cancer Data Base. J Neurooncol 40:1511601998Surawicz TS Davis F Freels S et al: Brain tumor survival: results from the National Cancer Data Base. J Neurooncol 40:151–160 1998

54.

Takeuchi K: [Role of chemotherapy in long-term survival of malignant glioma.] No Shinkei Geka 3:8158201975 (Jpn)Takeuchi K: [Role of chemotherapy in long-term survival of malignant glioma.] No Shinkei Geka 3:815–820 1975 (Jpn)

55.

Takeuchi KHoshino K: Statistical analysis of factors affecting survival after glioblastoma multiforme. Acta Neurochir 37:57731977Takeuchi K Hoshino K: Statistical analysis of factors affecting survival after glioblastoma multiforme. Acta Neurochir 37:57–73 1977

56.

Taveras JMThompson HG JrPool JL: Should we treat glioblastoma multiforme? A study of survival in 425 cases. AJR 87:4734791962Taveras JM Thompson HG Jr Pool JL: Should we treat glioblastoma multiforme? A study of survival in 425 cases. AJR 87:473–479 1962

57.

Ullen HMattsson BCollins VP: Long-term survival after malignant glioma. A clinical and histopathological study on the accuracy of the diagnosis in a population-based cancer register. Acta Oncol 29:8758781990Ullen H Mattsson B Collins VP: Long-term survival after malignant glioma. A clinical and histopathological study on the accuracy of the diagnosis in a population-based cancer register. Acta Oncol 29:875–878 1990

58.

Vertosick FT JrSelker RG: Long-term survival after the diagnosis of malignant glioma: a series of 22 patients surviving more than 4 years after diagnosis. Surg Neurol 38:3593631992Vertosick FT Jr Selker RG: Long-term survival after the diagnosis of malignant glioma: a series of 22 patients surviving more than 4 years after diagnosis. Surg Neurol 38:359–363 1992

59.

Wester KBjerkvig RCressey Let al: Organ culture of a glioblastoma from a patient with an unusually long survival. Neurosurgery 35:4284331994Wester K Bjerkvig R Cressey L et al: Organ culture of a glioblastoma from a patient with an unusually long survival. Neurosurgery 35:428–433 1994

60.

Winger MJMacdonald DRCairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71:4874931989Winger MJ Macdonald DR Cairncross JG: Supratentorial anaplastic gliomas in adults. The prognostic importance of extent of resection and prior low-grade glioma. J Neurosurg 71:487–493 1989

61.

Yoshida TKawano NOka Het al: Clinical cure of glioblastoma—two case reports. Neurol Med Chir 40:2242292000Yoshida T Kawano N Oka H et al: Clinical cure of glioblastoma—two case reports. Neurol Med Chir 40:224–229 2000

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