TY - JOUR
T1 - Prognostic factors in medulloblastoma, including DNA ploidy
AU - Zerbini, Claudia
AU - Gelber, Richard D.
AU - Weinberg, David
AU - Sallan, Stephen E.
AU - Barnes, Patrick
AU - Kupsky, William
AU - Scott, R. Michael
AU - Tarbell, Nancy J.
PY - 1993
Y1 - 1993
N2 - Purpose; DNA ploidy status, completeness of surgical resection, use of chemotherapy, adequacy of radiation therapy, metastatic stage, sex, and age at diagnosis were evaluated as predictors of relapse in 58 patients with cerebellar medulloblastoma. Methods; Flow cytometry (FCM) and/or image analysis (IA) were used to characterize tumor DNA ploidy. Twelve tumors (21%) were found to be aneuploid, 11 (19%) tetraploid, and 35 (60%) diploid. Results; The most significant predictors of relapse in univariate analyses were the adequacy of radiation (≥ 50 Gy) (P = .02), metastatic staging (P = .05), completeness of resection (P = .085), and DNA ploidy status (diploid/tetraploid v aneuploid; P = .11). When the 52 patients who received ≥ 50 Gy were included in a multivariate Cox model analysis, those with diploid/tetraploid tumors had fewer recurrences than those with aneuploid tumors (relative risk, 0.33; 95% confidence interval, 0.12 to 0.89; P = .03). Patients with complete resections (P = .07), or with stage MO disease (P = .06) had fewer recurrences than other patients, but these factors were not independent predictors of outcome. DNA ploidy status was correlated with age; 10 of the 12 aneuploid tumors were found in children ages 3 to 10 years. Age, sex, and the use of chemotherapy were not prognostically significant in these analyses. Conclusion; The adequacy of radiation dose and DNA ploidy were the most important prognostic factors in this series. Contrary to previous reports, when corrected for adequacy of treatment, DNA aneuploidy was associated with a poor outcome. By multivariate analyses, DNA ploidy was an independent variable, even when controlling for extent of surgical resection and metastatic stage.
AB - Purpose; DNA ploidy status, completeness of surgical resection, use of chemotherapy, adequacy of radiation therapy, metastatic stage, sex, and age at diagnosis were evaluated as predictors of relapse in 58 patients with cerebellar medulloblastoma. Methods; Flow cytometry (FCM) and/or image analysis (IA) were used to characterize tumor DNA ploidy. Twelve tumors (21%) were found to be aneuploid, 11 (19%) tetraploid, and 35 (60%) diploid. Results; The most significant predictors of relapse in univariate analyses were the adequacy of radiation (≥ 50 Gy) (P = .02), metastatic staging (P = .05), completeness of resection (P = .085), and DNA ploidy status (diploid/tetraploid v aneuploid; P = .11). When the 52 patients who received ≥ 50 Gy were included in a multivariate Cox model analysis, those with diploid/tetraploid tumors had fewer recurrences than those with aneuploid tumors (relative risk, 0.33; 95% confidence interval, 0.12 to 0.89; P = .03). Patients with complete resections (P = .07), or with stage MO disease (P = .06) had fewer recurrences than other patients, but these factors were not independent predictors of outcome. DNA ploidy status was correlated with age; 10 of the 12 aneuploid tumors were found in children ages 3 to 10 years. Age, sex, and the use of chemotherapy were not prognostically significant in these analyses. Conclusion; The adequacy of radiation dose and DNA ploidy were the most important prognostic factors in this series. Contrary to previous reports, when corrected for adequacy of treatment, DNA aneuploidy was associated with a poor outcome. By multivariate analyses, DNA ploidy was an independent variable, even when controlling for extent of surgical resection and metastatic stage.
KW - Aneuploidy
KW - Cerebellar Neoplasms/genetics
KW - Child
KW - Child, Preschool
KW - DNA, Neoplasm/genetics
KW - Female
KW - Humans
KW - Male
KW - Medulloblastoma/genetics
KW - Ploidies
KW - Prognosis
KW - Radiotherapy Dosage
KW - Retrospective Studies
KW - Survival Rate
UR - http://www.scopus.com/inward/record.url?scp=0027528491&partnerID=8YFLogxK
U2 - 10.1200/JCO.1993.11.4.616
DO - 10.1200/JCO.1993.11.4.616
M3 - Article
C2 - 8478656
AN - SCOPUS:0027528491
SN - 0732-183X
VL - 11
SP - 616
EP - 622
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 4
ER -