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Published in: Journal of Neuro-Oncology 1/2011

01-08-2011 | Clinical Study - Patient Study

Transformation of low grade glioma and correlation with outcome: an NCCTG database analysis

Authors: K. A. Jaeckle, P. A. Decker, K. V. Ballman, P. J. Flynn, C. Giannini, B. W. Scheithauer, R. B. Jenkins, J. C. Buckner

Published in: Journal of Neuro-Oncology | Issue 1/2011

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Abstract

Glioblastomas (GBM) may originate de novo (primary), or following transformation from a lower grade glioma (secondary), and it has been postulated that these tumors may have different biological behaviors. We performed a correlative analysis involving 204 patients with glioma treated prospectively on NCCTG clinical trials. Central pathology review of tumor tissues taken at the time of initial diagnosis and at recurrence were performed in all patients. Tumors progressed from low (WHO grade 2) to high (grade 3–4) at recurrence in 45% low grade oligodendroglioma patients, in 70% with low grade oligoastrocytoma, and 74% with low grade astrocytoma (P = 0.031). Median overall survival (OS) from initial diagnosis varied by histology: oligodendroglioma, 8.8 years; (95% CI 5.7–10.2); oligoastrocytoma, 4.4 years (95% CI 3.5–5.6); astrocytoma grade 2 3.1 years (astrocytoma grade 2–4, 2.1 years) (95% CI 1.7–2.5, P < 0.001). Mean time to recurrence (TTR) also varied between patients with de novo GBM, those secondary GBM, and those that remained non-GBM at recurrence (1.1 ± 1.1 vs. 2.9 ± 1.8 vs. 4.0 ± 2.9 years, respectively, P < 0.001). Median OS from time of recurrence also varied between these three categories (0.7 years, 95% CI: 0.5–1.1 vs. 0.6 years, CI: 0.5–1.0 vs. 1.4 years, 95% CI: 1.1–2.0, respectively) (P < 0.001). At time of relapse, transformation to higher grade is frequent in low grade pure and mixed astrocytomas, but is observed in less than half of those with low grade oligodendroglioma. From time of recurrence, OS was not significantly different for those with primary versus secondary GBM, and it may thus be reasonable include patients with secondary GBM in clinical therapeutic trials for recurrent disease.
Literature
1.
go back to reference Wu W, Lamborn KR, Buckner JC, Novotny P, Chang SM, O’Fallon JR, Galanis E, Jaeckle KA, Prados MD (2010) Joint NCCTG and NABTC prognostic factors analysis for high grade recurrent glioma. Neuro Oncol 12(2):164–172PubMed Wu W, Lamborn KR, Buckner JC, Novotny P, Chang SM, O’Fallon JR, Galanis E, Jaeckle KA, Prados MD (2010) Joint NCCTG and NABTC prognostic factors analysis for high grade recurrent glioma. Neuro Oncol 12(2):164–172PubMed
2.
go back to reference Ohgaki H (2007) Kleihues: genetic pathways to primary and secondary glioblastoma. Am J Path 170:1445–1453PubMedCrossRef Ohgaki H (2007) Kleihues: genetic pathways to primary and secondary glioblastoma. Am J Path 170:1445–1453PubMedCrossRef
3.
go back to reference Dropcho EJ, Soong SJ (1996) The prognositic impact of prior low grade histology in patients with anaplastic gliomas: a case-control study. Neurology 47:684–690PubMed Dropcho EJ, Soong SJ (1996) The prognositic impact of prior low grade histology in patients with anaplastic gliomas: a case-control study. Neurology 47:684–690PubMed
4.
go back to reference Ohgaki H, Dessen P, Jourde B et al (2004) Genetic pathways to glioblastoma: a population-based study. Cancer Res 64:6892–6899PubMedCrossRef Ohgaki H, Dessen P, Jourde B et al (2004) Genetic pathways to glioblastoma: a population-based study. Cancer Res 64:6892–6899PubMedCrossRef
5.
go back to reference Ohgaki H (2005) Kleihues: population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol 64:479–489PubMed Ohgaki H (2005) Kleihues: population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol 64:479–489PubMed
6.
go back to reference Pignatti F, van den Bent M, Curran D, European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084PubMedCrossRef Pignatti F, van den Bent M, Curran D, European Organization for Research and Treatment of Cancer Radiotherapy Cooperative Group et al (2002) Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:2076–2084PubMedCrossRef
7.
go back to reference Chang EF, Smith JS, Chang SM et al (2008) Preoperative prognosic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:817–824PubMedCrossRef Chang EF, Smith JS, Chang SM et al (2008) Preoperative prognosic classification system for hemispheric low-grade gliomas in adults. J Neurosurg 109:817–824PubMedCrossRef
8.
go back to reference Law M, Oh S, Johnson G et al (2006) Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology: a second reference standard in the surgical and nonsurgical treatment of low-grade gliomas. Neurosurgery 58:1099–1107PubMedCrossRef Law M, Oh S, Johnson G et al (2006) Perfusion magnetic resonance imaging predicts patient outcome as an adjunct to histopathology: a second reference standard in the surgical and nonsurgical treatment of low-grade gliomas. Neurosurgery 58:1099–1107PubMedCrossRef
9.
go back to reference Caseiras B, Ciccarelli O, Altmann DR et al (2009) Low-grade gliomas: six-month tumor growth predicts patient outcome better than admission tumor volume, relative cerebral blood volume, and apparent diffusion coefficient. Radiology 253:505–512CrossRef Caseiras B, Ciccarelli O, Altmann DR et al (2009) Low-grade gliomas: six-month tumor growth predicts patient outcome better than admission tumor volume, relative cerebral blood volume, and apparent diffusion coefficient. Radiology 253:505–512CrossRef
10.
go back to reference Kruer MC, Kaplan AM, Etzl MM Jr et al (2009) The value of positron emission tomography and proliferation index in predicting progression in low-grade astrocytomas of childhood. J Neurooncol 95:239–245PubMedCrossRef Kruer MC, Kaplan AM, Etzl MM Jr et al (2009) The value of positron emission tomography and proliferation index in predicting progression in low-grade astrocytomas of childhood. J Neurooncol 95:239–245PubMedCrossRef
11.
go back to reference Smith JS, Perry A, Borell TJ et al (2000) Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendrogliomas, astrocytomas and mixed oligoastrocytomas. J Clin Oncol 18:636–645PubMed Smith JS, Perry A, Borell TJ et al (2000) Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendrogliomas, astrocytomas and mixed oligoastrocytomas. J Clin Oncol 18:636–645PubMed
12.
go back to reference Huang Q, Zhang QB, Dong J et al (2008) Glioma stem cells are more aggressive in recurrent tumors with malignant progression than in the de novo tumor, and both can be maintained long-term in vitro. BMC Cancer 8:304PubMedCrossRef Huang Q, Zhang QB, Dong J et al (2008) Glioma stem cells are more aggressive in recurrent tumors with malignant progression than in the de novo tumor, and both can be maintained long-term in vitro. BMC Cancer 8:304PubMedCrossRef
13.
go back to reference Sanai N, Berger MS (2009) Operative techniques for gliomas and the value of extent of resection. Neurotherapeutics 6:478–486PubMedCrossRef Sanai N, Berger MS (2009) Operative techniques for gliomas and the value of extent of resection. Neurotherapeutics 6:478–486PubMedCrossRef
14.
go back to reference Shaw EG, Berkey B, Coons SW et al (2008) Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg 109:835–841PubMedCrossRef Shaw EG, Berkey B, Coons SW et al (2008) Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg 109:835–841PubMedCrossRef
15.
go back to reference Chang EF, Clark A, Jensen RL et al (2009) Multiinstitutional validation of the University of California at San Francisco Low-Grade Glioma Prognostic Scoring System. Clinical article. J Neurosurg 111:203–210PubMedCrossRef Chang EF, Clark A, Jensen RL et al (2009) Multiinstitutional validation of the University of California at San Francisco Low-Grade Glioma Prognostic Scoring System. Clinical article. J Neurosurg 111:203–210PubMedCrossRef
16.
go back to reference Martinez R, Rohde V, Schackert G: Different molecular patterns in glioblastoma multiforme subtypes upon recurrence. J Neurooncol 2009; Jul 31 (epub ahead of print) Martinez R, Rohde V, Schackert G: Different molecular patterns in glioblastoma multiforme subtypes upon recurrence. J Neurooncol 2009; Jul 31 (epub ahead of print)
17.
go back to reference Martinez R, Setien F, Voelter C et al (2007) CpG island promoter hypermethylation of the pro-apoptotic gene caspase-8 is a common hallmark of relapsed glioblastoma multiforme. Carcinogenesis 28:1264–1268PubMedCrossRef Martinez R, Setien F, Voelter C et al (2007) CpG island promoter hypermethylation of the pro-apoptotic gene caspase-8 is a common hallmark of relapsed glioblastoma multiforme. Carcinogenesis 28:1264–1268PubMedCrossRef
18.
go back to reference Maher EA, Brennan C, Wen PY et al (2006) Marked genomic differences characterize de novo and secondary glioblastoma subtypes and identify two distinct molecular and clinical secondary glioblastoma entities. Cancer Res 66:11502–11513PubMedCrossRef Maher EA, Brennan C, Wen PY et al (2006) Marked genomic differences characterize de novo and secondary glioblastoma subtypes and identify two distinct molecular and clinical secondary glioblastoma entities. Cancer Res 66:11502–11513PubMedCrossRef
19.
go back to reference Zheng H, Ying H, Yan H, Kimmelman AC et al (2008) p53 and PTEN control neural and glioma stem/progenitor cell renewal and differentiation. Nature 455:1129–1133PubMedCrossRef Zheng H, Ying H, Yan H, Kimmelman AC et al (2008) p53 and PTEN control neural and glioma stem/progenitor cell renewal and differentiation. Nature 455:1129–1133PubMedCrossRef
20.
go back to reference Ruano Y, Ribalta T, de Lope AR et al (2009) Worse outcome in de novo glioblastoma multiforme with concurrent epidermal growth factor receptor and p53 alteration. Am J Clin Pathol 131:257–263PubMedCrossRef Ruano Y, Ribalta T, de Lope AR et al (2009) Worse outcome in de novo glioblastoma multiforme with concurrent epidermal growth factor receptor and p53 alteration. Am J Clin Pathol 131:257–263PubMedCrossRef
21.
go back to reference Xie D, Zeng YX, Wang HJ et al (2006) Expression of cytoplasmic and nuclear survivin in de novo and secondary human glioblastoma. Br J Cancer 94:108–114PubMedCrossRef Xie D, Zeng YX, Wang HJ et al (2006) Expression of cytoplasmic and nuclear survivin in de novo and secondary human glioblastoma. Br J Cancer 94:108–114PubMedCrossRef
22.
go back to reference Somasundaram K, Reddy SP, Vinnakota K et al (2005) Upregulation of ASCL1 and inhibition of Notch signaling pathway characterize progressive astrocytoma. Oncogene 24:7073–7083PubMedCrossRef Somasundaram K, Reddy SP, Vinnakota K et al (2005) Upregulation of ASCL1 and inhibition of Notch signaling pathway characterize progressive astrocytoma. Oncogene 24:7073–7083PubMedCrossRef
23.
go back to reference Mineo JF, Bordron A, Baroncini M et al (2007) Low HER2-expressing glioblastomas are more often secondary to anaplastic transformation of low-grade glioma. J Neurooncol 85:281–287PubMedCrossRef Mineo JF, Bordron A, Baroncini M et al (2007) Low HER2-expressing glioblastomas are more often secondary to anaplastic transformation of low-grade glioma. J Neurooncol 85:281–287PubMedCrossRef
24.
go back to reference Nobusawa S, Watanabe T, Kleihues P et al (2009) IDH1 mutations as a molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res 15:6002–6007PubMedCrossRef Nobusawa S, Watanabe T, Kleihues P et al (2009) IDH1 mutations as a molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res 15:6002–6007PubMedCrossRef
25.
go back to reference Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345PubMedCrossRef Smith JS, Chang EF, Lamborn KR et al (2008) Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 26:1338–1345PubMedCrossRef
Metadata
Title
Transformation of low grade glioma and correlation with outcome: an NCCTG database analysis
Authors
K. A. Jaeckle
P. A. Decker
K. V. Ballman
P. J. Flynn
C. Giannini
B. W. Scheithauer
R. B. Jenkins
J. C. Buckner
Publication date
01-08-2011
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 1/2011
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-010-0476-2

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