Prognostic factors in pediatric high-grade astrocytoma: The importance of accurate pathologic diagnosis

Russell K. Hales, Ori Shokek, Peter C. Burger, Nina P. Paynter, Kaisorn L. Chaichana, Alfredo Quiñones-Hinojosa, George I. Jallo, Kenneth J. Cohen, Danny Y. Song, Benjamin S. Carson, Moody D. Wharam

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

To characterize a population of pediatric high-grade astrocytoma (HGA) patients by confirming the proportion with a correct diagnosis, and determine prognostic factors for survival in a subset diagnosed with uniform pathologic criteria. Sixty-three children diagnosed with HGA were treated at the Johns Hopkins Hospital between 1977 and 2004. A single neuropathologist (P.C.B.) reviewed all available histologic samples (n = 48). Log-rank analysis was used to compare survival by patient, tumor, and treatment factors. Median follow-up was 16 months for all patients and 155 months (minimum 54 months) for surviving patients. Median survival for all patients (n = 63) was 14 months with 10 long-term survivors (survival >48 months). At initial diagnosis, 27 patients were grade III (43%) and 36 grade IV (57%). Forty-eight patients had pathology slides available for review, including seven of ten long-term surviving patients. Four patients had non-HGA pathology, all of whom were long term survivors. The remaining 44 patients with confirmed HGG had a median survival of 14 months and prognostic analysis was confined to these patients. On multivariate analysis, five factors were associated with inferior survival: performance status (Lansky) <80% (13 vs. 15 months), bilaterality (13 vs. 19 months), parietal lobe location (13 vs. 16 months), resection less than gross total (13 vs. 22 months), and radiotherapy dose <50 Gy (9 vs. 16 months). Among patients with more than one of the five adverse factors (n = 27), median survival and proportion of long-term survivors were 12.9 months and 0%, compared with 41.4 months and 18% for patients with 0-1 adverse factors (n = 17). In an historical cohort of children with HGA, the potential for long term survival was confined to the subset with less than two of the following adverse prognostic factors: low performance status, bilaterality, parietal lobe site, less than gross total resection, and radiotherapy dose <50 Gy. Pathologic misdiagnosis should be suspected in patients who are long term survivors of a pediatric high grade astrocytoma.

Original languageEnglish (US)
Pages (from-to)65-71
Number of pages7
JournalJournal of neuro-oncology
Volume99
Issue number1
DOIs
StatePublished - Aug 1 2010

Keywords

  • Anaplastic
  • Glioblastoma
  • Glioma
  • Misdiagnosis
  • Pediatrics
  • Prognosis
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Neurology
  • Clinical Neurology
  • Cancer Research

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    Hales, R. K., Shokek, O., Burger, P. C., Paynter, N. P., Chaichana, K. L., Quiñones-Hinojosa, A., Jallo, G. I., Cohen, K. J., Song, D. Y., Carson, B. S., & Wharam, M. D. (2010). Prognostic factors in pediatric high-grade astrocytoma: The importance of accurate pathologic diagnosis. Journal of neuro-oncology, 99(1), 65-71. https://doi.org/10.1007/s11060-009-0102-3