The Prognostic Value of DNA Ploidy; DI and DNA Histogram Pattern Levels in Astrocytic Tumors
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Forty cases of astrocytic tumors were studied; 47.5% AST, 40% ANA and 12.5% G.B.M. Tumor DNA ploidy was analysed on paraffin-embedded and Feulgen stained tissue sections by the CAS-200 image analysis system. Follow up of the cases for 40 months was also studied to correlate histopathologic grades and DNA ploidy of tumors with the patient free survival time in trial to find out their prognostic value. The current study showed that the histopathologic grading of astrocytic tumors by means of a three division classification; astrocytoma (AST), artaplastic astrocytoma (ANA) and glioblastoma multiforme (GBM), had a significant prognostic value (73.6% of patients with AST, 43.75Zof ANA group and only 20% of GBM group were surviving free after 40 months follow up). Considering DNA ploidy characterization, it showed that aneuploid AST and ANA tumors were associated with longer mean patient free survival time (all 5 cases of aneuploid AST and 46.4% of ANA were surviving free till 40 months follow up) compared with euploid AST and ANA tumors (71.4%, 33.3% respectively). Not only high grade astrocytic tumors (ANA and GBM) but 26.3% of low grade astrocytic tumor (AST) were aneuploid, which means that classifying DNA ploidy into euploid (DI <1.3) and aneuploid (DI 1.3) types is unreliable to charcterize the grade of astrocytic tumors. Recognizing six DNA histogram types (diploid, triploid, tetraploid, hyperdiploid, hypertriploid and polymorhic), is a reliable method in determining the outcome of astorcytic tumors it was observed that triploid or near triploid (hyperdiploid and hypertriploid) astrocytic tumors (87.5% , 100% respectively) were associated with longer mean patient free survival time compared with that in cases of the other DNA histogram types regardless of the histopathologic grade of the tumor. In conclusion, this study suggests that in case of astrocytic tumors, histopathologic grading and DNA ploidy (at DI and DNA histogram pattern levels) could be helpful as shared prognostic values.