Article
Not only genetic factors of gliomas determine outcome
Nicht nur genetische Merkmale bestimmen Ergebnisvorhersage bei Patient*Innen mit Gliomen
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Authors
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Aleksandrs Krigers
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Patrizia Moser
- Landeskrankenhaus Innsbruck, Institut für Pathologie, Innsbruck, Österreich
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Matthias Demetz
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Johannes Kerchbaumer
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Claudius Thomé
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
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Christian F. Freyschlag
- Medizinische Universität Innsbruck, Universitätsklinik für Neurochirurgie, Innsbruck, Österreich
| Published: | June 4, 2021 |
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Outline
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Objective: The updated WHO classification stratifies diffuse or anaplastic gliomas with the extensive use of molecular features. Clinical trials for the treatment of those tumors were mostly done before the classification update, leading to a lack of knowledge in how to treat our patients. Therefore, we evaluated patients with gliomas, that were assessed according to the previous phenotypical WHO classification (before 2016). We compared the acquired genetic markers – IDH1, ATRX and EGFR – with the clinical outcome.
Methods: All consecutive patients with diffuse or anaplastic glioma WHO °II & III, operated at our institution between 2010 and 2019, were evaluated. IDH1, ATRX and EGFR IHC testing using FFPE tissue from the institutional biobank was performed, if these features had not already been assessed routinely. Clinical and follow-up data were gained from our neurooncological database.
Results: From 202 evaluated cases, IDH1 was not tested in 50, ATRX not in 78 and EGFR not in 63. From these, FFPE tissue was available and immunohistochemistry performed for 30 IDH1, 48 ATRX and 44 EGFR samples. In 16 (53%) IDH1 was mutated and in 14 (47%) wild-type, nuclear ATRX was expressed in 26 (54%) and lost in 24 (46%) cases, EGFR showed advanced expression in 24 (55%) cases, moderate in 11 (25%) and none in 9 cases (20%).
The decision for adjuvant treatment was not influenced by the molecular features that have been unknown at that time (p>0.05). In the group of known IDH1 gliomas it did affect the decision for CTX (p=0.035) or RTX (p=0.031) after surgery. This decision was not affected by ATRX or EGFR status of the tumor, even if it was known (p>0.05).
The fact that IDH1, ATRX or EGFR were known, did not influence the OS in our series (CoxReg, p>0.05 for each). In multivariate Cox-regression, only IDH1 (HR 2.1, p=0.05) affected the OS, but also WHO Grade (HR 9.0, p<0.01), preoperative tumor T1 CE volume (HR 1.03/cc, p=0.02), postoperative T1 CE tumor volume (HR 1.21/cc, p<0.01) as well as postoperative T2 volume of remnant tumor and perifocal oedema (HR 1.01/cc, p<0.01).
Conclusion: Genetic features of diffuse and anaplastic gliomas support but do not exclusively define the understanding of tumor behaviour. Other factors like WHO grade and determination of tumor volumes as well as contrast enhancement remain crucial.
