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Int J Clin Exp Pathol 2012;5(2):152-158

Original Article
Prognostic value of histological features in diffuse astrocytomas WHO grade II

Tove Lind-Landström1, Andreas Hanssøn Habberstad1, Stien Sundstrøm2, Sverre Helge Torp1,3

1Department of Laboratory Medicine, Children’s and Women’s Health, University Hospital, NTNU, Trondheim, Norway; the 2Department of
Oncology; the 3Department of Pathology and Medical Genetics, St. Olavs Hospital, Norway.

Received February 1, 2012; Accepted February 10, 2012; Epub February 12, 2012; Published February 28, 2012

Abstract: The histopathological diagnosis of diffuse astrocytoma is challenging. As the WHO classification system is based on subjective
assessments, the prognosis for the individual patient is somewhat uncertain. The aim of this study was therefore to investigate the prognostic
value of various histological features, Ki-67/MIB-1 labeling index (LI), and clinical factors. The study was designed as a retrospective study of
109 patients consecutively operated for their primary diffuse astrocytoma WHO grade II. Clinical data was collected from patient files. All routine
stained sections were revised, and 20 different histological features were recorded, including cell density, atypia, mitoses, apoptoses,
secondary structures (of Scherer), microcysts, and lymphocytic infiltration. Ki-67/MIB-1 LI was determined by conventional
immunohistochemistry. Using uni- and multivariate analyses the prognostic value of these factors was assessed as well as clinical
parameters. Median age at primary surgery was 40 years (range 18-75). The median overall survival was 70 months with a minimum follow-up
of 3 months. Neither histopathological features nor Ki-67/MIB-1 LI (median value of 4.5% (range 0.1-16%) indicated unfavorable prognosis.
However, age > 40 years, gender (male), poor preoperative performance score, and biopsy rather than resection were significant negative
prognostic factors in both uni- and multivariate analyses. Among diffuse grade II astrocytomas neither any histopathological trait nor Ki-67/MIB-
1 LI achieved prognostic significance, whereas clinical parameters were shown to serve as the major prognostic factors for these patients.

Keywords: Brain neoplasms, brain tumours, gliomas, histopathology, proliferation, survival

Address all correspondence to:
Dr. Sverre H Torp
Department of Pathology and Medical Genetics
St. Olavs Hospital, NO-7006 Trondheim
Tel: +4772573365; Fax: +4772576428
E-mail: sverre.torp@ntnu.no