Correlates of survival and the Daumas-Duport grading system for astrocytomas

Restricted access

✓ In order to examine the correlation between prognosis and the histological features of nuclear atypia, mitosis, endothelial proliferation, and necrosis in supratentorial adult astrocytomas, the authors reviewed 251 such cases treated at the Massachusetts General Hospital between 1972 and 1980. One point was given for the presence of each feature. The total number of features was translated into a grade as follows: none of the four features = Grade 1 (one patient), one feature = Grade 2 (36 patients), two features = Grade 3 (33 patients), and three or four features = Grade 4 (181 patients). The period of survival was significantly associated with grade, the presence or absence of each of the four histological features, patient's age, type of operation, radiation therapy, and extent of tumor (log rank, p < 0.05). The variables associated with grade were age (p < 0.001) and radiation therapy (p < 0.02). After adjustment for these variables using a Cox proportional-hazards model, the difference in overall survival time between patients in Grades 2 and 3 was not statistically significant. When comparable groups of patients were examined in terms of age or receipt of radiation therapy, the median survival times differed markedly. Patients 50 years of age or less had a median survival time of 68 months (Grade 2 tumors), 29 months (Grade 3 tumors), and 13 months (Grade 4 tumors). Patients over 50 years of age had a median survival time of 6 months (Grade 2 and 4 tumors) and 9 months (Grade 3 tumors). Those patients who had received radiation therapy had a median survival time of 68 months (Grade 2 tumors), 21 months (Grade 3 tumors), and 11 months (Grade 4 tumors). Those patients who did not receive radiation therapy had a median survival time of 1 month (Grade 2 tumors) and 2 months (Grade 3 and 4 tumors); over half of these patients died within 2 months of surgery. This grading system, originally proposed by Daumas-Duport, et al., is simple, objective, and reproducible, and correlates well with survival times. The authors recommend that astrocytomas be graded on a scale of 1 to 4, with Grade 1 reserved for the rare adult supratentorial astrocytoma with none of the four histological features.

Article Information

Contributor Notes

Address reprint requests to: E. Tessa Hedley-Whyte, M.D., C. S. Kubik Laboratory for Neuropathology, Massachusetts General Hospital, Boston, Massachusetts 02114.
Headings
References
  • 1.

    Ammirati MVick NLiao Yet al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:2012061987Ammirati M Vick N Liao Y et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206 1987

    • Search Google Scholar
    • Export Citation
  • 2.

    Becker DPBenyo RRoessmann U: Glial origin of monstrocellular tumor. Case report of prolonged survival. J Neurosurg 26:72771967Becker DP Benyo R Roessmann U: Glial origin of monstrocellular tumor. Case report of prolonged survival. J Neurosurg 26:72–77 1967

    • Search Google Scholar
    • Export Citation
  • 3.

    Broders AC: Carcinoma grading and practical applications. Arch Pathol Lab Med 2:3763811926Broders AC: Carcinoma grading and practical applications. Arch Pathol Lab Med 2:376–381 1926

    • Search Google Scholar
    • Export Citation
  • 4.

    Broders AC: The grading of carcinoma. Minn Med 8:7267301925Broders AC: The grading of carcinoma. Minn Med 8:726–730 1925

  • 5.

    Burger PCGreen SB: Patient age, histologic features, and length of survival in patients with glioblastoma multiforme. Cancer 59:161716251987Burger PC Green SB: Patient age histologic features and length of survival in patients with glioblastoma multiforme. Cancer 59:1617–1625 1987

    • Search Google Scholar
    • Export Citation
  • 6.

    Burger PCVogel FSGreen SBet al: Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer 56:110611111985Burger PC Vogel FS Green SB et al: Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer 56:1106–1111 1985

    • Search Google Scholar
    • Export Citation
  • 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

    • Search Google Scholar
    • Export Citation
  • 8.

    Childhood Brain Tumor Consortium: A study of childhood brain tumors based on surgical biopsies from ten North American institutions: sample description. J Neurooncol 6:9231988Childhood Brain Tumor Consortium: A study of childhood brain tumors based on surgical biopsies from ten North American institutions: sample description. J Neurooncol 6:9–23 1988

    • Search Google Scholar
    • Export Citation
  • 9.

    Daumas-Duport CScheithauer BO'Fallon Jet al: Grading of astrocytomas. A simple and reproducible method. Cancer 62:215221651988Daumas-Duport C Scheithauer B O'Fallon J et al: Grading of astrocytomas. A simple and reproducible method. Cancer 62:2152–2165 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Daumas-Duport CSzikla C: Délimitation et configuration spatiale des gliomes cérébraux. Données histologiques, incidences thérapeutiques. Neurochirurgie 27:2732841981Daumas-Duport C Szikla C: Délimitation et configuration spatiale des gliomes cérébraux. Données histologiques incidences thérapeutiques. Neurochirurgie 27:273–284 1981

    • Search Google Scholar
    • Export Citation
  • 11.

    Elvidge AR: Long-term survival in the astrocytoma series. J Neurosurg 28:3994041968Elvidge AR: Long-term survival in the astrocytoma series. J Neurosurg 28:399–404 1968

    • Search Google Scholar
    • Export Citation
  • 12.

    Elvidge ARMartinez-Coll A: Long-term follow-up of 106 cases of astrocytoma, 1928–1939. J Neurosurg 13:3183311956Elvidge AR Martinez-Coll A: Long-term follow-up of 106 cases of astrocytoma 1928–1939. J Neurosurg 13:318–331 1956

    • Search Google Scholar
    • Export Citation
  • 13.

    Frankel SAGerman WJ: Glioblastoma multiforme. Review of 219 cases with regard to natural history, pathology, diagnostic methods, and treatment. J Neurosurg 15:4895031958Frankel SA German WJ: Glioblastoma multiforme. Review of 219 cases with regard to natural history pathology diagnostic methods and treatment. J Neurosurg 15:489–503 1958

    • Search Google Scholar
    • Export Citation
  • 14.

    Fulling KHGarcia DM: Anaplastic astrocytoma of the adult cerebrum. Prognostic value of histologic features. Cancer 55:9289311985Fulling KH Garcia DM: Anaplastic astrocytoma of the adult cerebrum. Prognostic value of histologic features. Cancer 55:928–931 1985

    • Search Google Scholar
    • Export Citation
  • 15.

    Garcia-Bengochea FCollins GH: Monstrocellular sarcoma of the brain: 6-year postoperative survival. Case report. J Neurosurg 31:6866891969Garcia-Bengochea F Collins GH: Monstrocellular sarcoma of the brain: 6-year postoperative survival. Case report. J Neurosurg 31:686–689 1969

    • Search Google Scholar
    • Export Citation
  • 16.

    Gehan EAWalker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:1891951977Gehan EA Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:189–195 1977

    • Search Google Scholar
    • Export Citation
  • 17.

    Gulotta F: Morphological and biological basis for the WHO-classification 1979. Adv Tech Stand Neurosurg 8:1231651981Gulotta F: Morphological and biological basis for the WHO-classification 1979. Adv Tech Stand Neurosurg 8:123–165 1981

    • Search Google Scholar
    • Export Citation
  • 18.

    Hadfield MGSilverberg SG: Light and electron microscopy of giant-celled glioblastoma. Cancer 30:9899961972Hadfield MG Silverberg SG: Light and electron microscopy of giant-celled glioblastoma. Cancer 30:989–996 1972

    • Search Google Scholar
    • Export Citation
  • 19.

    Hitselberger WEKernohan JWUihlein A: Giant cell fibrosarcoma of brain. Cancer 14:8418521961Hitselberger WE Kernohan JW Uihlein A: Giant cell fibrosarcoma of brain. Cancer 14:841–852 1961

    • Search Google Scholar
    • Export Citation
  • 20.

    Hoshino TPrados MWilson CBet al: Prognostic implications of the bromodeoxyuridine labeling index of human gliomas. J Neurosurg 71:3353411989Hoshino T Prados M Wilson CB et al: Prognostic implications of the bromodeoxyuridine labeling index of human gliomas. J Neurosurg 71:335–341 1989

    • Search Google Scholar
    • Export Citation
  • 21.

    Kaplan ELMeier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:4574811958Kaplan EL Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481 1958

    • Search Google Scholar
    • Export Citation
  • 22.

    Kernohan JWMabon RFSvien HJet al: A simplified classification of gliomas. Proc Staff Meet Mayo Clin 24:71751949Kernohan JW Mabon RF Svien HJ et al: A simplified classification of gliomas. Proc Staff Meet Mayo Clin 24:71–75 1949

    • Search Google Scholar
    • Export Citation
  • 23.

    Kernohan JWSayre GP: Tumors of the central nervous system in: Atlas of Tumor Pathology Section 10 Vols 35 and 37. Washington, DC: Armed Forces Institute of Pathology1952Kernohan JW Sayre GP: Tumors of the central nervous system in: Atlas of Tumor Pathology Section 10 Vols 35 and 37. Washington DC: Armed Forces Institute of Pathology 1952

    • Search Google Scholar
    • Export Citation
  • 24.

    Kersting GWullenberg R: Recurrences of gliomas. A comparative clinical and morphological study with note on the histological grading of astrocytomas in Hasegawa THayashi MEbling FJet al (eds): Modern Aspects of Neurosurgery. International Congress Series No. 278. Amsterdam: Excerpta Medica1973 pp 116121Kersting G Wullenberg R: Recurrences of gliomas. A comparative clinical and morphological study with note on the histological grading of astrocytomas in Hasegawa T Hayashi M Ebling FJ et al (eds): Modern Aspects of Neurosurgery. International Congress Series No. 278. Amsterdam: Excerpta Medica 1973 pp 116–121

    • Search Google Scholar
    • Export Citation
  • 25.

    Lynn JAPanopio ITMartin JHet al: Ultrastructural evidence for astroglial histogenesis of the monstrocellular astrocytoma (so-called monstrocellular sarcoma of brain). Cancer 22:3563661968Lynn JA Panopio IT Martin JH et al: Ultrastructural evidence for astroglial histogenesis of the monstrocellular astrocytoma (so-called monstrocellular sarcoma of brain). Cancer 22:356–366 1968

    • Search Google Scholar
    • Export Citation
  • 26.

    Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:1631701966Mantel N: Evaluation of survival data and two new rank order statistics arising in its consideration. Cancer Chemother Rep 50:163–170 1966

    • Search Google Scholar
    • Export Citation
  • 27.

    Matthews DEFarewell VT: Using and Understanding Medical Statisticsed 3. New York: Karger1988 pp 6787Matthews DE Farewell VT: Using and Understanding Medical Statistics ed 3. New York: Karger 1988 pp 67–87

    • Search Google Scholar
    • Export Citation
  • 28.

    Nelson JSTsukada YSchoenfeld Det al: Necrosis as a prognostic criterion in malignant supratentorial, astrocytic gliomas. Cancer 52:5505541983Nelson JS Tsukada Y Schoenfeld D et al: Necrosis as a prognostic criterion in malignant supratentorial astrocytic gliomas. Cancer 52:550–554 1983

    • Search Google Scholar
    • Export Citation
  • 29.

    Ringertz N: Grading of gliomas. Acta Pathol Microbiol Scand 27:53641950Ringertz N: Grading of gliomas. Acta Pathol Microbiol Scand 27:53–64 1950

    • Search Google Scholar
    • Export Citation
  • 30.

    Rubinstein LJ: Tumors of the central nervous system in: Atlas of Tumor Pathology Series 2 Fascicle 6. Washington, DC: Armed Forces Institute of Pathology1972Rubinstein LJ: Tumors of the central nervous system in: Atlas of Tumor Pathology Series 2 Fascicle 6. Washington DC: Armed Forces Institute of Pathology 1972

    • Search Google Scholar
    • Export Citation
  • 31.

    Russell DSRubinstein LJ: Pathology of Tumours of the Nervous Systemed 5. Baltimore: Williams & Wilkins1989 pp 83161Russell DS Rubinstein LJ: Pathology of Tumours of the Nervous System ed 5. Baltimore: Williams & Wilkins 1989 pp 83–161

    • Search Google Scholar
    • Export Citation
  • 32.

    Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:4354391980Salcman M: Survival in glioblastoma: historical perspective. Neurosurgery 7:435–439 1980

    • Search Google Scholar
    • Export Citation
  • 33.

    SAS Users Guide: Statistics Version 5. Cary, NC: SAS Institute1985SAS Users Guide: Statistics Version 5. Cary NC: SAS Institute 1985

    • Search Google Scholar
    • Export Citation
  • 34.

    Svien HJMabon RFKernohan JWet al: Astrocytomas. Proc Staff Meet Mayo Clin 25:54641949Svien HJ Mabon RF Kernohan JW et al: Astrocytomas. Proc Staff Meet Mayo Clin 25:54–64 1949

    • Search Google Scholar
    • Export Citation
  • 35.

    Tani TMasaru NItagaki Jet al: Cell membrane structure of human giant-celled glioblastoma. Acta Neuropathol 41:61651978Tani T Masaru N Itagaki J et al: Cell membrane structure of human giant-celled glioblastoma. Acta Neuropathol 41:61–65 1978

    • Search Google Scholar
    • Export Citation
  • 36.

    Tooth HH: Some observations on the growth and survival-period of intracranial tumours, based on the records of 500 cases, with special reference to the pathology of thegliomata. Brain 35:611081912Tooth HH: Some observations on the growth and survival-period of intracranial tumours based on the records of 500 cases with special reference to the pathology of thegliomata. Brain 35:61–108 1912

    • Search Google Scholar
    • Export Citation
  • 37.

    Walker MDAlexander E JrHunt WEet al: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:3333431978Walker MD Alexander E Jr Hunt WE et al: Evaluation of BCNU and/or radiotherapy in the treatment of anaplastic gliomas. A cooperative clinical trial. J Neurosurg 49:333–343 1978

    • Search Google Scholar
    • Export Citation
  • 38.

    Weir B: The relative significance of factors affecting postoperative survival in astrocytomas, grades 3 and 4. J Neurosurg 38:4484521973Weir B: The relative significance of factors affecting postoperative survival in astrocytomas grades 3 and 4. J Neurosurg 38:448–452 1973

    • Search Google Scholar
    • Export Citation
  • 39.

    Zülch KJ: Histological Typing of Tumours of the Central Nervous System. Geneva: World Health Organization1979 pp 1757Zülch KJ: Histological Typing of Tumours of the Central Nervous System. Geneva: World Health Organization 1979 pp 17–57

    • Search Google Scholar
    • Export Citation
  • 40.

    Zülch KJWechsler W: Pathology and classification of gliomas. Prog Neurol Surg 2:11841968Zülch KJ Wechsler W: Pathology and classification of gliomas. Prog Neurol Surg 2:11–84 1968

    • Search Google Scholar
    • Export Citation
TrendMD
Cited By
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 251 237 67
Full Text Views 197 83 0
PDF Downloads 102 36 0
EPUB Downloads 0 0 0
PubMed
Google Scholar