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Necrosis as a Prognostic Factor in Glioblastoma Multiforme, Cancer, Volume 77, Issue 6

- The presence or absence of necrosis has been used as a key diagnostic

criterion for the most anaplastic form of astrocytic neoplasm, the glioblas-
toma multiforme (GM)

- Necrosis was positively correlated with age, with older patients more likely to have tumors containing necrosis
(Spearman P = 0.01). There was no correlation between necrosis and KPS (P = 0.5). A trend ( P = 0.05) was noted
toward more frequent presence of necrosis in specimens from gross total resections (30 of 31 patients; 97%)
compared with subtotal resections (175 of 198 patients; 88%) or biopsies (38 of 46 patients; 83%)
- The absence of necrosis predicted longer survival in univariate analysis ( P = 0.02). Patients without tumor necro
sis had a median survival of 12.5 months (95% confidence interval, 10.2 to 22 months), and those with tumor
necrosis had a median survival of 10.9 months (95% confidence interval, 9.6 to 12.5 months) (Fig. 1).
- In multivariate analysis, after adjustment for age, KPS, and extent of resection, absence of necrosis was still a
statistically significant predictor of longer survival (P =0.04)
- Necrosis proved to be a prognostic factor predicting shorter survival in our study group. However, the magnitude
of the survival difference between patients with and without tumor necrosis was small: median survival was 10.9
months and 12.5 months, respectively
Radiological assessment of necrosis in glioblastoma: variability and prognostic value

Abstract - In a previous study, we found that the extent of necrosis was the only radiological feature which correlated
significantly with survival in patients with glioblastoma. The aim of this paper was to evaluate the variability and prognostic
value of the extent of the necrotic area as seen on contrast-enhanced MRI and CT in a larger series. We studied 72 patients
who underwent surgical removal of supratentorial glioblastomas and had CT and/or MRI with contrast medium before
surgery; 38, all undergoing the same treatment (surgery plus radiotherapy), were followed clinically. Necrosis within the
tumour varied greatly, ranging from none (only 1 case) to involvement of 76 % of the tumour. Survival data in the subgroup
suggested that only patients with a small area of necrosis (less than 35 % of the tumour) had a significantly longer survival
time. When necrosis involved more than 35 % of the mass, patients had a shorter survival time, without any further
correlation with the extent of necrosis.

- In the 72 patients the mean N/T was 0.43 0.21 (range 0.00.8), and the median 0.46.
- There was no significant relationship between the extent of necrosis and the total volume
of the tumour.
- Patients with N/T < 0.47 survived on average 17.42 months, whereas those with N/T >
0.47 survived on average 10.32 5 months; these times were significantly different (p =
- The relative risk (RR) was markedly higher in patients with N/T 0.350.53 and N/T > 0.53
than in those with N/T K 0.35
- Necrosis may therefore be the most important sign of both rapid development and
malignancy of brain tumours.