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Malignant brainstem gliomas in adults: clinicopathological characteristics and prognostic factors

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Abstract

Adult malignant brainstem gliomas (BSGs) are poorly characterized due to their relative rarity. We have examined histopathologically confirmed cases of adult malignant BSGs to better characterize the patient and tumor features and outcomes, including the natural history, presentation, imaging, molecular characteristics, prognostic factors, and appropriate treatments. A total of 34 patients were identified, consisting of 22 anaplastic astrocytomas (AAs) and 12 glioblastomas (GBMs). The overall median survival for all patients was 25.8 months, with patients having GBMs experiencing significantly worse survival (12.1 vs. 77.0 months, p = 0.0011). The majority of tumors revealed immunoreactivity for EGFR (93.3 %) and MGMT (64.7 %). Most tumors also exhibited chromosomal abnormalities affecting the loci of epidermal growth factor receptor (92.9 %), MET (100 %), PTEN (61.5 %), and 9p21 (80 %). AAs more commonly appeared diffusely enhancing (50.0 vs. 27.3 %) or diffusely nonenhancing (25.0 vs. 0.0 %), while GBMs were more likely to exhibit focal enhancement (54.6 vs. 10.0 %). Multivariate analysis revealed confirmed histopathology for GBM to significantly affect survival (HR 4.80; 95 % CI 1.86–12.4; p = 0.0012). In conclusion, adult malignant BSGs have an overall poor prognosis, with GBM tumors faring significantly worse than AAs. As AAs and GBMs have differing imaging characteristics, tissue diagnosis may be necessary to accurately determine patient prognosis and identify molecular characteristics which may aid in the treatment of these aggressive tumors.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standards

The data collection and analyses performed in this study comply with the current laws of the United States.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, Duke University Medical Center, 2624, Durham, NC, 27710, USA

    Ranjith Babu, Vijay Agarwal, Allan H. Friedman & Cory Adamson

  2. Department of Radiology, Duke University Medical Center, Durham, NC, 27710, USA

    Peter G. Kranz

  3. Department of Pathology, Duke University Medical Center, Durham, NC, 27710, USA

    Roger E. McLendon

  4. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, 27710, USA

    Steven Thomas

  5. Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, 27710, USA

    Darell D. Bigner

  6. Neurosurgery Section, Durham VA Medical Center, Durham, NC, USA

    Cory Adamson

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  1. Ranjith Babu
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Correspondence to Vijay Agarwal.

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Babu, R., Kranz, P.G., Agarwal, V. et al. Malignant brainstem gliomas in adults: clinicopathological characteristics and prognostic factors. J Neurooncol 119, 177–185 (2014). https://doi.org/10.1007/s11060-014-1471-9

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  • DOI: https://doi.org/10.1007/s11060-014-1471-9

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