TY - JOUR
T1 - A pragmatic clinicopathobiological grouping/staging system for gliomas
T2 - Proposal of the Indian TNM subcommittee on brain tumors
AU - Gupta, Tejpal
AU - Sarin, Rajiv
AU - Jalali, Rakesh
AU - Sharma, Suash
AU - Kurkure, Purna
AU - Goel, Atul
PY - 2009/7/1
Y1 - 2009/7/1
N2 - Background: There is no universally accepted staging system for primary brain tumors wherein prognostication is mainly based on complex composite indices. Aim: To develop a simple, pragmatic, and widely applicable grouping/staging system for gliomas, the most common primary brain tumor. Materials and Methods: An expert neurooncology panel with representation from radiation oncology, neurosurgery, pathology, radiology, and medical oncology had several rounds of discussion on issues pertinent to brain tumor staging. The trade off was between the accuracy of prognostic categorization and a pragmatic, widely applicable approach. Results and Recommendations: The Tumor-Node-Metastasis staging was considered irrelevant for gliomas that seldom metastasize to lymphatics or outside the neuraxis. Instead, a 4-point staging/grouping system is proposed, using histological grade as the main prognostic variable and at least one stage migration based on other unfavorable features such as tumor location (brainstem); age (< 5 years for all grades, >50 years for high-grade, and >40 years for low-grade gliomas); poor neurological performance status (NPS 2-4); multicentricity and/or gliomatosis; and adverse biological parameters (proliferative index, angiogenesis markers, apoptotic index, cytogenetic abnormalities, and molecular markers). Conclusion: In absence of a grouping/staging system for primary brain tumors, prognostification is mostly based on complex composite indices. The proposed clinicopathobiological grouping/staging system for gliomas is a simple, pragmatic, and user-friendly tool with a potential to fulfill the objectives of staging classification.
AB - Background: There is no universally accepted staging system for primary brain tumors wherein prognostication is mainly based on complex composite indices. Aim: To develop a simple, pragmatic, and widely applicable grouping/staging system for gliomas, the most common primary brain tumor. Materials and Methods: An expert neurooncology panel with representation from radiation oncology, neurosurgery, pathology, radiology, and medical oncology had several rounds of discussion on issues pertinent to brain tumor staging. The trade off was between the accuracy of prognostic categorization and a pragmatic, widely applicable approach. Results and Recommendations: The Tumor-Node-Metastasis staging was considered irrelevant for gliomas that seldom metastasize to lymphatics or outside the neuraxis. Instead, a 4-point staging/grouping system is proposed, using histological grade as the main prognostic variable and at least one stage migration based on other unfavorable features such as tumor location (brainstem); age (< 5 years for all grades, >50 years for high-grade, and >40 years for low-grade gliomas); poor neurological performance status (NPS 2-4); multicentricity and/or gliomatosis; and adverse biological parameters (proliferative index, angiogenesis markers, apoptotic index, cytogenetic abnormalities, and molecular markers). Conclusion: In absence of a grouping/staging system for primary brain tumors, prognostification is mostly based on complex composite indices. The proposed clinicopathobiological grouping/staging system for gliomas is a simple, pragmatic, and user-friendly tool with a potential to fulfill the objectives of staging classification.
KW - Gliomas
KW - Prognosis
KW - Staging classification
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U2 - 10.4103/0028-3886.53261
DO - 10.4103/0028-3886.53261
M3 - Article
C2 - 19587462
AN - SCOPUS:67651174575
SN - 0028-3886
VL - 57
SP - 247
EP - 251
JO - Neurology India
JF - Neurology India
IS - 3
ER -