Microscopic Thrombi in Anaplastic Astrocytoma (AA) Predicts Worse Survival
NF Prayson, P Koch, L Angelov, RA Prayson. University School, Hunting Valley, OH; CCLCM, Cleveland, OH; Cleveland Clinic, Cleveland, OH
Background: It is well-known that certain brain tumors, such as glioblastoma, have a high incidence of intratumoral thrombi and an increased risk of developing deep venous thrombosis (DVT). The previously reported incidence of intratumoral thrombosis in AA is relatively low. The purpose of this study is to determine whether AA patients (pts) with intratumoral vascular thrombi have a worse survival than AA pts without thrombi.
Design: Retrospective review of 101 patients (pts) (60 males, 41 females; age range 1-85 years (yrs), mean 53.3 yrs) with AA (WHO grade III). Thrombi were counted (number of thrombi/blood vessels evaluated/10 high power fields) in the initially resected tumor (69 biopsies, 32 subtotal resections) and correlated with a variety of parameters including survival and development of postoperative DVT.
Results: Intravascular thrombi were identified in 17 AA (17%) (9 biopsies, 8 subtotal resections), of tumors with thrombi, the percentage of blood vessels with thrombi ranged from 1.5-20% (mean 5.6%). Ten pts were known to have received chemotherapy and 16 pts radiotherapy. Sixteen of 17 pts died of tumor (mean survival 15.4 months (mos), range 1-45 mos) and one patient was alive with tumor at 180 mos. The remaining 84 AA (83%) (60 biopsies, 24 subtotal resections) had no intravascular tumor thrombi; 57 pts received chemotherapy and 67 pts received radiotherapy. After follow-up, 75 of 84 pts without thrombi died of tumor (mean survival 26.5 months, range 0.5 - 139 months), 4 pts were alive (7, 8, 42, and 77 mos) and 5 pts were lost to follow-up. Evidence of DVT was found by ultrasound in 2 of 11 (18.2%) AA pts with thrombi who were tested versus 10 of 54 (18.5%)AA pts without thrombi.
Conclusions: Microscopic intratumoral thrombi were identified in 17% of AA. Pts with thrombi had a worse survival (mean 15.4 mos) versus AA pts without intratumoral thrombi (mean 26.5 mos), although the difference did not reach statistical significance. There appears to be no correlation between the presence or absence of intratumoral thrombi and the development of DVT.
Tuesday, March 23, 2010 1:00 PM
Poster Session IV # 225, Tuesday Afternoon