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Study of the MIB-1 Labeling Index as a Predictor of Tumor Progression in Pilocytic Astrocytomas in Children and Adolescents

Daniel C. Bowers, Lynn Gargan, Payal Kapur, Joan S. Reisch, Arlynn F. Mulne, Kenneth N. Shapiro, Roy D. Elterman, Naomi J. Winick, Linda R. Margraf

From the Departments of Pediatrics, Academic Computing Services, and Pathology, University of Texas Southwestern Medical Center at Dallas; and the Neuro-Oncology Program, Children’s Medical Center of Dallas, Dallas, TX.

Address reprint requests to Daniel Bowers, MD, MC 9063, Department of Pediatrics, University of Texas Southwestern Medical School at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063; email: daniel.bowers{at}utsouthwestern.edu.

Purpose: The pilocytic astrocytoma (PA) is the most common childhood brain tumor. This report examines the MIB-1 labeling index (LI) as a predictor of progression-free survival (PFS) among childhood PAs.

Patients and Methods: Consecutive PAs were examined to determine whether the MIB-1 LI was associated with tumor progression. Other variables evaluated included tumor location, use of adjuvant therapy, extent of resection, and age at diagnosis.

Results: One hundred forty-one children were identified (mean ± SD age, 7.6 ± 4.7 years; range, 0.43 to 18.56 years); 118 children had adequate tissue for MIB-1 immunohistochemistry. The 5-year PFS was 61.25%. By log-rank analysis, an MIB-1 LI of more than 2.0 was associated with shortened PFS (P = .035). Patients with PAs who underwent complete surgical resection, had tumors located in the cerebellum, and were treated with surgery only also had more prolonged PFS (P = .001 for all). Tumors in the optic pathways were associated with a shorter PFS (P = .001). Restricting the evaluation of MIB-1 LI to only incompletely resected tumors revealed an insignificant trend of MIB-1 LI of more than 2.0 having a shortened PFS. Multivariate analysis demonstrated completely resected tumors and tumors located in the cerebellum as less likely to progress (P = .001 and .019, respectively).

Conclusion: Children with PAs with an MIB-1 LI of more than 2.0 have a shortened PFS. PAs that are completely resected and are located in the cerebellum have a prolonged PFS. This initial study suggests that the MIB-1 LI identifies a more aggressive subset of PAs. Further work should focus on elucidating features of pilocytic astocytomas that will identify prospectively children at risk for progression.

Supported in part by the Children’s Brain Tumor Foundation of the Southwest, the Children’s Medical Center Foundation, and the Children’s Cancer Fund of Dallas, Dallas, TX.

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