Do Microscopic Thrombi in Glioblastoma Multiforme (GBM) Predict the Development of Deep Venus Thrombosis (DVT)?
NF Prayson, S Sethu, L Angelov, RA Prayson. University School, Cleveland, OH; Cleveland Clinic Foundation, Cleveland, OH
Background: Patients with GBM are known to be at risk for hypercoagulable events. Tumoral intravascular thrombi likely contribute to the development of hypoxia and necrosis. The purpose of this study is to assess whether there is a relationship between the number of thrombi identified microscopically at the time of tumor resection and the subsequent development of extremity DVT.
Design: Retrospective review of 96 patients (pts) (53 males and 43 females; age range 21-92 years, age mean 60.2 years) with GBM (WHO grade IV). Thrombi were counted (number of thrombi/blood vessels evaluated/10 high power fields) in nonnecrotic areas of the resected tumor and correlated with a variety of clinical and pathologic parameters including the development of postoperative DVT, as detected by extremity ultrasound.
Results: Thrombi were identified in the resected GBM in 66 pts (69%). Of the tumors with thrombi, the percentage of blood vessels with thrombi ranged from 1.1-42.9% (mean 10.7%). DVT were discovered in 30 pts (31.3%). There was no correlation between the number of microscopic thrombi and the development of DVT. Eighty one pts died of tumor (1-66 months survival, mean 10.4 months), 12 pts were alive at last known follow-up, and 3 pts were lost to followup. Of pts with DVT, 26 pts died of tumor (survival 1-47 months, mean 11.0 months), 3 pts were alive and 1 pt was lost to follow-up. There was no correlation between the number of microscopic thrombi and the percent of resected tumor which was necrotic (range <5-90%), presence of palisaded necrosis (36% of tumors), presurgical (mean 78) or post surgical (mean 75). Karnofsky performance scores (KPS), or survival (mean 8.9 months in pts with no microscopic thrombi versus mean 11.5 months in pts with thrombi).
Conclusions: Microscopic thrombi were identified in about 2/3 (69%) of GBM and DVT developed in about 1/3 (31.3%) of pts with GBM. There was no correlation between the number of microscopic thrombi and the subsequent development of DVT in pts with GBM. Pts who developed DVT did not appear to have a worse survival.
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 192, Tuesday Morning