Predictive factors for early symptomatic recurrence in pilocytic astrocytoma: does angiogenesis have a role to play?

We studied predictive factors with respect to angiogenesis and proliferative indices for early symptomatic recurrences in patients with pilocytic astrocytoma (PA). One hundred and eighteen patients who underwent surgery for PA were divided into non-recurrent and early symptomatic recurrence groups to analyze clinicoradiological and immunohistopathological (n=33) parameters. Patients with non-recurrent tumors presented with symptoms for a mean duration of 10.2 ± 9.1 months while those with recurrent tumors presented slightly earlier (6.9 ± 4.5 months). Common tumor locations were the cerebellum (38.1%), optic chiasm (27.9%), supratentorial region (19.4%) and brainstem (9.3%). Recurrent tumors were mostly located in the cerebellum (44%) and brainstem (33%). Strong contrast enhancement was noted in 70 (59.3%) tumors, while 48 (40.7%) showed poor contrast. Resection was complete in 53% of patients while near total excision was achieved for the remaining patients. Cellularity and pleomorphism were similar in both groups. Extensive endothelial proliferation was observed in 18.1% of patients while the remainder showed a focal pattern. Diffuse vascular endothelial growth factor (VEGF) expression was observed in 36.3% of patients while 63.6% showed mild-to-moderate focal expression. Endothelial proliferation and VEGF expression were more pronounced in patients with non-recurrent tumors, but this was not statistically significant. MIB-I labeling indices were similar (1-5%) for both groups. Symptomatic recurrences were common in infratentorial PAs. Radiology, histopathology and proliferative indices did not offer any prognostic information. Angiogenesis markers such as endothelial proliferation and VEFG expression did not predict early symptomatic recurrence. Diffuse VEGF expression and endothelial proliferation were observed in tumors that showed strong contrast enhancement.