Validation of EORTC prognostic factors for adults with low-grade glioma

A report using intergroup 86-72-51

Thomas B. Daniels, Paul D. Brown, Sara J. Felten, Wenting Wu, Jan Craig Buckner, Robert M. Arusell, Walter J. Curran, Ross A. Abrams, David Schiff, Edward G. Shaw

Research output: Contribution to journalArticle

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Abstract

Purpose: A prognostic index for survival was constructed and validated from patient data from two European Organisation for Research and Treatment of Cancer (EORTC) radiation trials for low-grade glioma (LGG). We sought to independently validate this prognostic index with a separate prospectively collected data set (Intergroup 86-72-51). Methods and Materials: Two hundred three patients were treated in a North Central Cancer Treatment Group-led trial that randomized patients with supratentorial LGG to 50.4 or 64.8 Gy. Risk factors from the EORTC prognostic index were analyzed for prognostic value: histology, tumor size, neurologic deficit, age, and tumor crossing the midline. The high-risk group was defined as patients with more than two risk factors. In addition, the Mini Mental Status Examination (MMSE) score, extent of surgical resection, and 1p19q status were also analyzed for prognostic value. Results: On univariate analysis, the following were statistically significant (p < 0.05) detrimental factors for both progression-free survival (PFS) and overall survival (OS): astrocytoma histology, tumor size, and less than total resection. A Mini Mental Status Examination score of more than 26 was a favorable prognostic factor. Multivariate analysis showed that tumor size and MMSE score were significant predictors of OS whereas tumor size, astrocytoma histology, and MMSE score were significant predictors of PFS. Analyzing by the EORTC risk groups, we found that the low-risk group had significantly better median OS (10.8 years vs. 3.9 years, p < 0.0001) and PFS (6.2 years vs. 1.9 years, p < 0.0001) than the high-risk group. The 1p19q status was available in 66 patients. Co-deletion of 1p19q was a favorable prognostic factor for OS vs. one or no deletion (median OS, 12.6 years vs. 7.2 years; p = 0.03). Conclusions: Although the low-risk group as defined by EORTC criteria had a superior PFS and OS to the high-risk group, this is primarily because of the influence of histology and tumor size. Co-deletion of 1p19q is a prognostic factor. Future studies are needed to develop a more refined prognostic system that combines clinical prognostic features with more robust molecular and genetic data.

Original languageEnglish (US)
Pages (from-to)218-224
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume81
Issue number1
DOIs
StatePublished - Sep 1 2011

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Glioma
grade
cancer
Survival
Research
Disease-Free Survival
tumors
histology
Neoplasms
Histology
Nervous System Neoplasms
progressions
deletion
examination
Astrocytoma
Therapeutics
Neurologic Manifestations
Molecular Biology
Multivariate Analysis
predictions

Keywords

  • Low-grade glioma
  • Prognostic factors
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Validation of EORTC prognostic factors for adults with low-grade glioma : A report using intergroup 86-72-51. / Daniels, Thomas B.; Brown, Paul D.; Felten, Sara J.; Wu, Wenting; Buckner, Jan Craig; Arusell, Robert M.; Curran, Walter J.; Abrams, Ross A.; Schiff, David; Shaw, Edward G.

In: International Journal of Radiation Oncology Biology Physics, Vol. 81, No. 1, 01.09.2011, p. 218-224.

Research output: Contribution to journalArticle

Daniels, Thomas B. ; Brown, Paul D. ; Felten, Sara J. ; Wu, Wenting ; Buckner, Jan Craig ; Arusell, Robert M. ; Curran, Walter J. ; Abrams, Ross A. ; Schiff, David ; Shaw, Edward G. / Validation of EORTC prognostic factors for adults with low-grade glioma : A report using intergroup 86-72-51. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 81, No. 1. pp. 218-224.
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AU - Wu, Wenting

AU - Buckner, Jan Craig

AU - Arusell, Robert M.

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AU - Abrams, Ross A.

AU - Schiff, David

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N2 - Purpose: A prognostic index for survival was constructed and validated from patient data from two European Organisation for Research and Treatment of Cancer (EORTC) radiation trials for low-grade glioma (LGG). We sought to independently validate this prognostic index with a separate prospectively collected data set (Intergroup 86-72-51). Methods and Materials: Two hundred three patients were treated in a North Central Cancer Treatment Group-led trial that randomized patients with supratentorial LGG to 50.4 or 64.8 Gy. Risk factors from the EORTC prognostic index were analyzed for prognostic value: histology, tumor size, neurologic deficit, age, and tumor crossing the midline. The high-risk group was defined as patients with more than two risk factors. In addition, the Mini Mental Status Examination (MMSE) score, extent of surgical resection, and 1p19q status were also analyzed for prognostic value. Results: On univariate analysis, the following were statistically significant (p < 0.05) detrimental factors for both progression-free survival (PFS) and overall survival (OS): astrocytoma histology, tumor size, and less than total resection. A Mini Mental Status Examination score of more than 26 was a favorable prognostic factor. Multivariate analysis showed that tumor size and MMSE score were significant predictors of OS whereas tumor size, astrocytoma histology, and MMSE score were significant predictors of PFS. Analyzing by the EORTC risk groups, we found that the low-risk group had significantly better median OS (10.8 years vs. 3.9 years, p < 0.0001) and PFS (6.2 years vs. 1.9 years, p < 0.0001) than the high-risk group. The 1p19q status was available in 66 patients. Co-deletion of 1p19q was a favorable prognostic factor for OS vs. one or no deletion (median OS, 12.6 years vs. 7.2 years; p = 0.03). Conclusions: Although the low-risk group as defined by EORTC criteria had a superior PFS and OS to the high-risk group, this is primarily because of the influence of histology and tumor size. Co-deletion of 1p19q is a prognostic factor. Future studies are needed to develop a more refined prognostic system that combines clinical prognostic features with more robust molecular and genetic data.

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