A pragmatic clinicopathobiological grouping/staging system for gliomas: Proposal of the Indian TNM subcommittee on brain tumors|
Gupta, Tejpal; Sarin, Rajiv; Jalali, Rakesh; Sharma, Suash; Kurkure, Purna & Goel, Atul
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.
Gliomas, prognosis, staging classification