Clinical Risk Factors Affecting Survival of Primary Cerebral Malignant Astrocytoma at a University Hospital in Western Saudi Arabia
Keywords:
Anaplastic astrocytoma, glioblastoma multiformeAbstract
Objective: Malignant astrocytomas are the most aggressive tumors affecting the brain. The natural history of survival of malignant astrocytomas differs significantly between anaplastic astrocytoma and glioblastoma multiforme (1). The clinical risk factors affecting the survival of malignant astrocytomas are scarcely studied (2). The aim of this study is to describe the clinical risk factors affecting the survival of malignant astrocytomas at king abdulaziz university hospital in Jeddah.
Materials and Method: From January 2004 to December 2008, medical files of patients with a diagnosis of anaplastic astrocytoma and glioblastoma multiforme were retrospectively reviewed. Only those with characteristic pathologic findings suggestive of malignant astrocytomas were enrolled. Demographic data and clinical manifestations with outcome were analyzed. All data were processed using SPSS 16 software (SPSS Inc., Chicago Illinois).The data were analysed for age, symptoms, signs and clinical risk factors influencing the survival of both tumours. Differences with p < 0.05 were considered significant.
Results: Forty eight cases were evaluated. The number of anaplastic astrocytoma was 15 (31.25%) and the number of GBM was 33 (68.75%). The mean age for glioblastoma multiforme was 55.3 ± 27.5 years. The mean age of anaplastic astrocytoma was 27.4 ± 21.3 years. Risk factors that worsen the prognosis were: A- old age p = .00002, B- Vomiting p < .02, C- Numbness p < .0001, D- Cranial nerves abnormalities p < .0004 and E- Abnor-mal mental status p < .003.
Conclusion: Clinical risk factors affecting the survival negatively of patients with malignant astrocytomas are age, presentation with vomiting, numbness, abnormal mental status and abnormal cranial nerves examination.
References
2. Chambless LB, Parker SL, Hassam – Malani L, McGirt MJ, Thompson RC. Type 2 diabetes mellitus and obesity are independent risk factors for poor outcome in patients with high – grade glioma. J Neurooncol 2011 Aug 11.
3. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, Davis FG. Descriptive epidemiology of primary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990 – 1994. Neuro Oncol 1999 Jan; 1 (1): 14-25.
4. Stupp R, Reni M, Gatta G, Mazza E, Vecht C. Anaplas-tic astrocytoma in adults. Crit Rev Oncol Hematol 2007 Jul; 63 (1): 72-80.
5. Burton EC, Prados MD. Malignant gliomas. Curr Treat Options Oncol 2000 Dec; 1 (5): 459-68.
6. Larjavaara S, Mantyla R, Salminen T, Haapasalo H, Raitanen J, Jaaskelainen J, et al. Incidence of gliomas by anatomic location. Neuro Oncol 2007 Jul; 9 (3): 319-25.
7. Surawicz TS, McCarthy BJ, Kupelian V, Jukich PJ, Bruner JM, Davis FG. Descriptive epidemiology of pri-mary brain and CNS tumors: results from the Central Brain Tumor Registry of the United States, 1990-1994. Neuro Oncol 1999 Jan; 1 (1): 14-25.
8. Kayama T, Kumabe T, Tominaga T, Yoshimoto T. Pro-gnostic value of complete response after the initial tre-atment for malignant astrocytoma. Neurol Res 1996 Aug; 18 (4): 321-4.
9. Tugcu B, Postalci LS, Gunaldi O, Tanriverdi O, Akde-mir H. Efficacy of clinical prognostic factors on survi-val in patients with glioblastoma. Turk Neurosurg 2010 Apr; 20 (2): 117-25.
10. Kyprianou I, Nassab R. A comparative study of referral patterns and management of patients with malignant brain tumours in Birmingham, UK, and Toronto, Cana-da. Br J Neurosurg 2005 Jun; 19 (3): 229-34.
11. Ayadi L, Charfi S, Khabir A, Kalle R, Sellami A, Mak-ni S, et al. (Cerebral gliosarcoma: clinico-pathologic study of 8 cases). Tunis Med 2010 Mar; 88 (3): 142-6.
12. Bianchi E, Podesta AF, Arico M. (Clinical course of brain tumors in childhood). Minerva Med 1984 Jun 8; 75 (24): 1407-11.
13. Guillamo JS, Monjour A, Taillandier L, Devaux B, Varlet P, Haie – Meder C, et al. Brainstem gliomas in adults: prognostic factors and classification. Brain 2001 Dec; 124 (Pt 12): 2528-39.
14. Soffietti R. Histologic and clinical factors of prognostic significance in astrocytic gliomas. J Neurosurg Sci 1990 Jul; 34 (3-4): 231-4.
15. Murakami R, Sugahara T, Nakamura H, Hirai T, Kitaji-ma M, Hayashida Y, et al. Malignant supratentorial as-trocytoma treated with postoperative radiation therapy: prognostic value of pretreatment quantitative diffusion-weighted MR imaging. Radiology 2007 May; 243 (2): 493-9.
16. Davis FG, Freels S, Grutsch J, Barlas S, Brem S. Survi-val rates in patients with primary malignant brain tum-ors stratified by patient age and tumor histological type: an analysis based on Surveillance, Epidemiology, and End Results (SEER) data, 1973 – 1991. J Neurosurg 1998 Jan; 88 (1): 1-10.
17. Adamson C, Kanu OO, Mehta AI, Di C, Lin N, Mattox AK, et al. Glioblastoma multiforme: a review of where we have been and where we are going. Expert Opin Investig Drugs 2009 Aug; 18 (8): 1061-83.
18. Kanu OO, Mehta A, Di C, Lin N, Bortoff K, Bigner DD, et al. Glioblastoma multiforme: a review of thera-peutic targets. Expert Opin Ther Targets 2009 Jun; 13 (6): 701-18.
19. Brandes AA, Tosoni A, Franceschi E, Reni M, Gatta G, Vecht C. Glioblastoma in adults. Crit Rev Oncol Hema-tol 2008 Aug; 67 (2): 139-52.
20. Bromowicz J, Kaluza J, Skolyszewski J, Goscinski I, Reinfuss M, Krzyszkowski T. [Results of combined tre-atment (by surgery, ionizing radiation and the cytostatic drug CCNU) of patients with anaplastic glial neoplasms of the brain]. Neurol Neurochir Pol 1986 Mar; 20 (2): 137-42.
21. Rekers NH, Sminia P, Peters GJ. Towards tailored the-rapy of glioblastoma multiforme. J Chemother 2011 Aug; 23 (4): 187-99.
22. Lakomy R, Fadrus P, Slampa P, Svoboda T, Kren L, Lzicarova E, et al. (Multimodal treatment of glioblas-toma multiforme: results of 86 consecutive patients dia-gnosed in period 2003 – 2009). Klin Onkol 2011; 24 (2): 112-20.
23. Marina O, Suh JH, Reddy CA, Barnett GH, Vogelbaum MA, Peereboom DM, et al. Treatment outcomes for patients with glioblastoma multiforme and a low Kar-nofsky Performance Scale score on presentation to a tertiary care institution. Clinical article. J Neurosurg 2011 Aug; 115 (2): 220-9.
24. Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK, et al. Effect of neurological dysfunc-tion on health – related quality of life in patients with high – grade glioma. J Neurooncol 1997 Sep; 34 (3): 263-78.
25. Hernandez – Reyna R, Medellin – Sanchez R, Cerda – Flores RM, Calderon – Garciduenas AL. (Survival pro-gnostic factors in Mexican patients with multiforme gli-oblastoma). Rev Med Inst Mex Seguro Soc 2010 Mar; 48 (2): 121-6.
26. Chaichana KL, Chaichana KK, Olivi A, Weingart JD, Bennett R, Brem H, et al. Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical arti-cle. J Neurosurg 2011 Mar; 114 (3): 587-94.
27. Chaichana KL, Halthore AN, Parker SL, Olivi A, Wei-ngart JD, Brem H, et al. Factors involved in maintain-ing prolonged functional independence following sup-ratentorial glioblastoma resection. Clinical article. J Neurosurg 2011 Mar; 114 (3): 604-12.
28. Allahdini F, Amirjamshidi A, Reza-Zarei M, Abdollahi M. Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: do-es maximal resection of the tumor lengthen the median survival? World Neurosurg 2010 Feb;73 (2): 128-34.
29. Stummer W, Tonn JC, Mehdorn HM, Nestler U, Franz K, Goetz C, et al. Counterbalancing risks and gains from extended resections in malignant glioma surgery: a supplemental analysis from the randomized 5 – ami-nolevulinic acid glioma resection study. Clinical article. J Neurosurg 2011 Mar; 114 (3): 613-23.
30. Whittle IR, Basu N, Grant R, Walker M, Gregor A. Ma-nagement of patients aged > 60 years with malignant glioma: good clinical status and radiotherapy determine outcome. Br J Neurosurg 2002 Aug; 16 (4): 343-7.
31. Osoba D, Aaronson NK, Muller M, Sneeuw K, Hsu MA, Yung WK, et al. Effect of neurological dysfunc-
tion on health – related quality of life in patients with high – grade glioma. J Neurooncol 1997 Sep; 34 (3): 263-78.
32. Kiwit JC, Floeth FW, Bock WJ. Survival in malignant glioma: analysis of prognostic factors with special regard to cytoreductive surgery. Zentralbl Neurochir 1996; 57 (2): 76-88.
33. Comte F, Bauchet L, Rigau V, Hauet JR, Fabbro M, Coubes P, et al. Correlation of preoperative thallium SPECT with histological grading and overall survival in adult gliomas. Nucl Med Commun 2006 Feb; 27 (2): 137-42.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
