{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:41:09Z","timestamp":1787499669362,"version":"build-2736575974"},"reference-count":45,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2022,9,3]],"date-time":"2022-09-03T00:00:00Z","timestamp":1662163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"\u201cOvidius\u201d University of Constanta","award":["3\/21.10.2021"],"award-info":[{"award-number":["3\/21.10.2021"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Grade 4 adult gliomas are IDH-mutant astrocytomas and IDH-wildtype glioblastomas. They have a very high mortality rate, with survival at 5 years not exceeding 5%. We aimed to conduct a clinical imaging and morphogenetic characterization of them, as well as to identify the main negative prognostic factors that give them such aggressiveness. We conducted a ten-year retrospective study. We followed the clinical, imaging, and morphogenetic aspects of the cases. We analyzed immunohistochemical markers (IDH1, Ki-67, and nestin) and FISH tests based on the CDKN2A gene. The obtained results were analyzed using SPSS Statistics with the appropriate parameters. The clinical aspects representing negative prognostic factors were represented by patients\u2019 comorbidities: hypertension (HR = 1.776) and diabetes mellitus\/hyperglycemia (HR = 2.159). The lesions were mostly supratentorial, and the temporal lobe was the most affected. The mean volume was 88.05 cm3 and produced a midline shift with an average of 8.52 mm. Subtotal surgical resection was a negative prognostic factor (HR = 1.877). The proliferative index did not influence survival rate, whereas CDKN2A gene mutations were shown to have a major impact on survival. We identified the main negative prognostic factors that support the aggressiveness of grade 4 gliomas: patient comorbidities, type of surgical resection, degree of cell differentiation, and CDKN2A gene mutations.<\/jats:p>","DOI":"10.3390\/clinpract12050073","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T23:35:57Z","timestamp":1662420957000},"page":"701-713","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Aggressiveness of Grade 4 Gliomas of Adults"],"prefix":"10.3390","volume":"12","author":[{"given":"Mariana","family":"Deacu","sequence":"first","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8525-3554","authenticated-orcid":false,"given":"Any","family":"Docu Axelerad","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Department of Neurology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steliana","family":"Popescu","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Department of Radiology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodor Sebastian","family":"Topliceanu","sequence":"additional","affiliation":[{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University of Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Aschie","sequence":"additional","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"},{"name":"Academy of Medical Sciences of Romania, 030167 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madalina","family":"Bosoteanu","sequence":"additional","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Faculty of Medicine, \u201cOvidius\u201d University of Constanta, 900470 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgeta Camelia","family":"Cozaru","sequence":"additional","affiliation":[{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University of Constanta, 900591 Constanta, Romania"},{"name":"Clinical Service of Pathology, Departments of Genetics, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria","family":"Cretu","sequence":"additional","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University of Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9396-2350","authenticated-orcid":false,"given":"Raluca Ioana","family":"Voda","sequence":"additional","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University of Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8039-3200","authenticated-orcid":false,"given":"Cristian Ionut","family":"Orasanu","sequence":"additional","affiliation":[{"name":"Clinical Service of Pathology, Departments of Pathology, \u201cSf. Apostol Andrei\u201d Emergency County Hospital, 900591 Constanta, Romania"},{"name":"Center for Research and Development of the Morphological and Genetic Studies of Malignant Pathology (CEDMOG), \u201cOvidius\u201d University of Constanta, 900591 Constanta, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: A summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro Oncol."},{"key":"ref_2","first-page":"vdaa175","article-title":"An updated histology recode for the analysis of primary malignant and nonmalignant brain and other central nervous system tumors in the Surveillance, Epidemiology, and End Results Program","volume":"3","author":"Forjaz","year":"2020","journal-title":"Neurooncol. 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