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72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

06.06. - 09.06.2021

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The clinical course of IDH1/2-wildtype astrocytomas

Der klinische Verlauf von IDH1/2-Wildtyp Astrozytomen

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  • presenting/speaker Naureen Keric - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
  • Harald Krenzlin - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Darius Kalasauskas - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland
  • Christian F. Freyschlag - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Christian von der Brelie - Universitätsmedizin Göttingen, Neurochirurgische Klinik und Poliklinik, Göttingen, Deutschland
  • Jens Gempt - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Aleksandrs Krigers - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Arthur Wagner - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Veit Rohde - Universitätsmedizin Göttingen, Neurochirurgische Klinik und Poliklinik, Göttingen, Deutschland
  • Claudius Thomé - Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
  • Bernhard Meyer - Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
  • Florian Ringel - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Klinik und Poliklinik für Neurochirurgie, Mainz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 72. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgie. sine loco [digital], 06.-09.06.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. DocV294

doi: 10.3205/21dgnc279, urn:nbn:de:0183-21dgnc2791

Published: June 4, 2021

© 2021 Keric et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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.