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Necrosis as a prognostic factor in glioblastoma multiforme
F G Barker1, R L Davis, S M Chang
1Neurosurgical Service, Massachusetts General Hospital, Boston 02114, USA.
Cancer
|March 15, 1996
Summary
Glioblastoma multiforme (GM) without tumor necrosis behaves similarly to GM with necrosis. This finding supports classifying these astrocytic neoplasms as grade 4 tumors in current grading systems.
Area of Science:
- Neuro-oncology
- Pathology
- Cancer Research
Background:
- Traditional glioblastoma multiforme (GM) diagnosis requires tumor necrosis.
- Newer grading systems allow GM diagnosis without necrosis.
- This study investigates the clinical significance of necrosis absence in GM.
Purpose of the Study:
- To determine if glioblastoma multiforme (GM) lacking tumor necrosis exhibits biological behavior consistent with GM or anaplastic astrocytoma (AA).
- To evaluate the prognostic impact of tumor necrosis in GM patients.
Main Methods:
- Examined survival data of 299 patients diagnosed with GM based on endothelial proliferation.
- Utilized multivariate proportional-hazards survival analysis to assess necrosis impact.
- Adjusted for prognostic factors including age, Karnofsky performance score, and resection extent.
Main Results:
- 88% of GMs with endothelial proliferation showed tumor necrosis.
- Absence of necrosis was linked to younger patients and less extensive resection.
- While necrosis absence predicted longer survival in univariate and multivariate analyses, the difference was not clinically significant (median survival 12.5 vs. 10.9 months).
Conclusions:
- Survival patterns for astrocytic neoplasms with endothelial proliferation but no necrosis align with GM, not AA.
- Supports classifying these tumors as GM in the revised WHO grading system and grade 4 astrocytomas in the St. Anne-Mayo system.