Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas

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Abstract
Prognostic factors for adult patients with supratentorial World Health Organization (WHO) Grade 2 astrocytomas are poorly defined. The prognostic importance of pretreatment patient- and tumor-related factors was analyzed retrospectively in 197 adult patients with supratentorial astrocytomas (n = 153) or oligoastrocytomas (n = 44) using the multivariate Cox proportional hazards model. Endpoints were death and date of malignant transformation. All patients were treated similarly between 1979 and 1992 with iodine-125 implants as the primary treatment. A new prognostic pattern was detected. Unfavorable prognostic factors with regard to survival were 1) a tumor volume ≥ 20 mL; 2) a performance status ≤ 80; and 3) age ≥ 40 years for the female subpopulation. Midline shift (another important tumor-related factor after univariate analysis) was highly correlated with tumor volume and therefore not included in the multivariate model. Risk factors of malignant transformation were 1) a tumor volume ≥ 20 mL; 2) an enhancement in the computed tomography scan; and 3) age ≥ 40 years for the female subpopulation. Prognostic factors created subsets of patients with 5-year survival rates ranging from as low as 5% to as high as 79%. Any treatment decision or evaluation of treatment efficacy should take into account the strong influence of both patient- and tumor-related factors. Any further study design should consider the detected interaction between gender and age and the importance of tumor volume. Cancer 1997; 79:370-9. © 1997 American Cancer Society.