Prognostic relevance of cell proliferation markers and DNA-ploidy in gliomas.

The prognostic significance of clinically, histologically and flow cytometrically derived parameters was assessed in 49 glioma patients. With flow cytometry, DNA-index, S-phase fraction (SPF), 5-bromo-2'-deoxyuridine (BrdUrd)-labelling index (LI), and potential doubling time (Tpot) were determined. After univariate analysis of clinical variables such as, age, seizures as initial symptom, and duration of first symptom were found to be significantly associated both with proliferation rate and with local progression free survival (LPFS). Cytomorphological features such as, the presence or absence of mitosis, necrosis, and endothelial proliferation, were separately analysed and appeared to be significantly associated with LPFS. With respect to the cell proliferation markers, we observed a longer LPFS to be associated with a low SPF, a low LI, and a short Tpot. We did not observe a significant association between DNA-ploidy and LPFS. After multivariate analysis both of high and of low grade tumours, we found that neither LI, SPF, nor age had additional prognostic significance for cells in mitoses. We also demonstrated, that necrosis and endothelial proliferation had no additional prognostic significance to that for cells in mitoses. In the subgroup of low grade gliomas, in contrast to high grade gliomas, we noted prognostic significance for LI. We concluded, that i) the presence or absence of cells in mitoses was the strongest single prognosticator in gliomas, ii) in low grade gliomas LI holds prognostic significance.