Artikel
The clinical course of IDH1/2-wildtype astrocytomas
Der klinische Verlauf von IDH1/2-Wildtyp Astrozytomen
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: DH1/2-wildtype (wt) astrocytomas have a high recurrence rate. Since the cIMPACT-NOW update 3, the subgroup of diffuse tumors with certain molecular markers are categorized as WHO IV tumors. Treatment recommendation has shifted to a more aggressive strategy. In this study, we aimed to evaluate the treatment related clinical course of IDH1/2-wt astrocytomas graded as II or III without inclusion of molecular markers.
Methods: The medical records of all patients who underwent surgery (2016-2019 in 4 neurosurgical departments) for a histologically diagnosed IDH1/2-wt astrocytoma WHO II-III according to light microscopy were reviewed to assess the progression-free survival (PFS), overall survival (OS) and prognostic factors.
Results: This multicenter retrospective study included 90 patients (median age 57 years; 44.4% female). Mean follow-up was 16.2 months (SD 12.1). The predominant histology was anaplastic astrocytoma WHO III (76.7%), followed by diffuse astrocytoma WHO II (22.2%) and diffuse glioma with molecular markers of a glioblastoma WHO IV (7.8%). Gross total resection (GTR) was achieved in 46.6% of patients, subtotal resection in 34.2% and biopsy was performed in 19.2%. Mean PFS (18.4; SD 9.6 months) and OS (32.2; SD 7.2 months) did not differ among the WHO grades. Independent from WHO grade, GTR lead to a significant increase of PFS in comparison to STR (P=0.012) and biopsy (P=0.002). 81.1% of patients were treated by the Stupp regimen, while 7.8% underwent radiotherapy alone, 4.4% received chemotherapy alone and 6.7% had no treatment due to unknown reasons. The loss of nuclear ATRX expression resulted in a significant longer PFS (HR:0.56 95% CI 0.34-0.91; P=0.017), while strong amplification of EGFR shortened the PFS (HR:3.08 95% CI 1.06-8.96; P=0.001). No influence of the TERT-promotor mutation or MGMT-promotor methylation on PFS and OS could be detected. Younger age, GTR and low ECOG-score were associated with a significantly prolonged PFS (age: HR:1.02 95% CI 1.003-1.04; P=0.022; ECOG: HR:0.55 95% CI 1.14-2.10; P=0.024; GTR: HR:0.30 95% CI 0.14-0.63; P=0.002).
Conclusion: In the present study no difference in PFS of IDH1/2-wt astrocytomas WHO II-IV undergoing same treatment regimen could be detected. Retained nuclear ATRX expression and a high EGFR amplification were associated with a poorer prognosis. Similar to glioblastoma the most important prognostic factors remained the extent of resection, age and clinical status.