Abstract
The favorable prognosis of high-grade oligodendroglial tumor such as glioblastoma (GBM) with oligodendroglioma component (GBMO) has been suggested; however, the studies which examine the prognostic significance of oligodendroglial tumor were limited. In this study, we performed a histopathology-based reevaluation of 111 cases of high grade gliomas according to the latest World Health Organization (WHO), and compared the clinical outcomes between oligodendroglial tumors and pure astrocytic tumors. The survival analysis revealed that the patients with high grade oligodendroglial tumor including GBMO significantly indicated better prognosis compared to the patients with high grade pure astrocytic tumors (GBM and AA, anaplastic astrocytoma) as expected, and the obtained survival curves were almost identical to those from the patients with conventional Grade III or Grade IV tumors, respectively. Moreover, if the cases of oligodendroglial tumor were histopathologically excluded, the patients with AA exhibited extremely poor prognosis which was similar to that of GBM, suggesting that the histological identification of oligodendroglial tumor component, even partially, prescribe the prognosis of high grade glioma patients. This is the prominent report of retrospective clinicopathological analysis for high-grade gliomas throughout Grade III and IV, especially referring to the prognostic value of histological oligodendroglial tumor component; in addition, our results might offer an alternative aspect for the grading of high-grade astrocytic/oligodendroglial tumors.
Highlights
High grade gliomas/malignant gliomas are composed of astrocytic and/or oligodendroglial tumors which are categorized into World Health Organization (WHO) grade III and IV
The recent clinical Phase III trial of anaplastic gliomas revealed that AO and anaplastic oligoastrocytoma (AOA) shared the similar prognosis, which was better than that for AA [14]
Regarding Glioblastoma with oligodendroglioma component (GBMO), its prognostic evaluation still remains controversial [5,6,7,8,9,10], here we have shown that the prognosis of GBMO, at least in terms of progressionfree survival (PFS), and in terms of the tendency for overall survival (OS), was significantly better than that of GBM
Summary
High grade gliomas/malignant gliomas are composed of astrocytic and/or oligodendroglial tumors which are categorized into WHO grade III and IV. In addition to variable prognostic factors such as the age of the patients, the extent of resection or postoperative radiation therapy, tumor grade and Karnofsky performance status (KPS) score, the presence of the oligodendroglial tumor component, prominent microvascular proliferation and/or necrosis in high-grade glioma are focused upon in the recent edition of WHO Classification (4th, 2007) [4]. A detailed survival analysis limited in Grade III gliomas, between oligodendroglial tumor (AO, AOA) and pure astrocytic tumor (Anaplastic astrocytoma, AA), has not been reported, especially after the recent edition of WHO Classification; the clinicopathological significance of the oligodendroglial tumor component is still controversial. We reviewed and analyzed 111 cases of high grade gliomas based on the latest WHO classification, and found the critical implication between the prognosis and histological evaluation, especially the presence of the oligodendroglial tumor component
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