Peritumoral Edema Affects the Prognosis in Adult Pleomorphic Xanthoastrocytoma: Retrospective Analysis of 25 Patients

Author links open overlay panelJoonhoByunSeok HoHongoung-HoonKimJeong HoonKimChang JinKim

https://doi.org/10.1016/j.wneu.2018.03.007Get rights and content

Highlights

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PXA is a very rare glial neoplasm, and the clinical and radiologic features of PXA are not uniform.

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Tumor size and peritumoral edema are possible prognostic factors of adult PXA.

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Peritumoral edema may be associated with recurrence in PXA WHO grade II.

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DWI, PWI, and PET findings failed to predict the clinical behavior and histologic grade of PXA.

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PXA showed a high recurrence rate, and thus, close follow-up is needed.

Background

Pleomorphic xanthoastrocytoma (PXA) is a very rare glial neoplasm. The clinical behavior of PXA is not uniform, and the purpose of this study was to investigate the clinical characteristics of adult PXA and identify prognostic factors.

Methods

Twenty-five patients aged 18 years or older who were diagnosed with PXA between 2002 and 2016 were analyzed.

Results

Twenty-one patients (84%) had PXA World Health Organization (WHO) grade II and 4 patients (16%) had anaplastic PXA (WHO grade III). The median overall survival of PXA WHO grade II and III was 97 and 56 months, respectively. The 3-year progression-free survival of PXA WHO grade II and III was 65.1% and 50%, respectively (P = 0.37 and 0.21). Diffusion-weighted imaging, perfusion-weighted imaging, and positron emission tomographyfindings failed to predict the histologic grade of PXA and recurrence of PXA WHO grade II. Tumor size >40 mm and presence of evident peritumoral edema (ePTE) were prognostic factors for poor progression-free survival (hazard ratios, 4.4 and 15.2, respectively; P = 0.03 and 0.01) according to a univariate analysis. In the recurrent and silent PXA grade II groups, ePTE was present in 87.5% and 23.1% of cases, respectively (P <0.01).

Conclusions

The clinical and radiologic features of PXA are not uniform. Tumor size and ePTE are possible prognostic factors for adult PXA. Also, peritumoral edema may be associated with recurrence in PXA WHO grade II. PXA showed a high recurrence rate, and thus close follow-up is needed.

Key words

Peritumoral edema

Pleomorphic xanthoastrocytoma

Recurrence

Abbreviations and Acronyms

ADC

Apparent diffusion coefficient

CI

Confidence interval

DWI

Diffusion-weighted imaging

EOR

Extent of resection

ePTE

Evident peritumoral edema

GIC

Glioblastoma initiating cell

GTR

Gross total resection

HPF

High-power field

HR

Hazard ratio

MRI

Magnetic resonance imaging

OS

Overall survival

PET

Positron emission tomography

PFS

Progression-free survival

PTE

Peritumoral edema

PWI

Perfusion-weighted imaging

PXA

Pleomorphic xanthoastrocytoma

RT

Radiotherapy

STR

Subtotal resection

WHO

World Health Organization

https://www.sciencedirect.com/science/article/pii/S187887501830473X