• Xian-Xin Qiu, Chen-Hong Wang, Zhi-Xiong Lin, Na You, Xing-Fu Wang, Yu-Peng Chen, Long Chen, Shui-Yuan Liu, and De-Zhi Kang.
• Tumor Invasion Micro-ecological Laboratory, Fujian Medical University; and 
• J. Neurosurg. 2015 Dec 1;123(6):1578-85.

ObjectPeritumoral brain edema (PTBE) is a common phenomenon associated with high-grade gliomas (HGGs). In this study, the authors investigated the expression of Notch delta-like ligand 4 (DLL4) and its correlation with PTBE and prognosis in patients with an HGG.MethodsTumors from 99 patients with HGG were analyzed for DLL4 expression using immunohistochemistry. PTBE on preoperative MR images and the relationship between PTBE and DLL4 expression were evaluated. The effect of DLL4 on patient prognosis was assessed by using Kaplan-Meier survival and Cox proportional hazard models.ResultsImmunohistochemistry results revealed that the expression of DLL4 was distributed primarily within the cytoplasm of tumor vascular endothelial cells and seldom detected in tumor cells. DLL4 expression was correlated positively with the degree of edema (r = 0.845 and p < 0.001, Spearman's test). In addition, DLL4 was an independent predictor of prognosis in patients with HGGs (p = 0.001).ConclusionsDLL4 expression was correlated positively with the degree of PTBE and was an independent unfavorable prognostic indicator in patients with HGG.

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