Treatment outcome of IDH1/2 wildtype CNS WHO grade 4 glioma histologically diagnosed as WHO grade II or III astrocytomas.

Autor: Keric N; Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. Naureen.keric@unimedizin-mainz.de., Krenzlin H; Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany., Kalasauskas D; Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany., Freyschlag CF; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Schnell O; Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany., Misch M; Department of Neurosurgery, Charité University Berlin, Berlin, Germany., von der Brelie C; Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany., Gempt J; Department of Neurosurgery, Technical University Munich, Munich, Germany., Krigers A; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Wagner A; Department of Neurosurgery, Technical University Munich, Munich, Germany., Lange F; Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany., Mielke D; Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany., Sommer C; Institute of Neuropathology, University Medical Center Mainz, Mainz, Germany., Brockmann MA; Department of Neuroradiology, University Medical Center Mainz, Mainz, Germany., Meyer B; Department of Neurosurgery, Technical University Munich, Munich, Germany., Rohde V; Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany., Vajkoczy P; Department of Neurosurgery, Charité University Berlin, Berlin, Germany., Beck J; Department of Neurosurgery, Medical Center University of Freiburg, Freiburg, Germany., Thomé C; Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria., Ringel F; Department of Neurosurgery, University Medical Center Mainz, Johannes Gutenberg University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Jazyk: angličtina
Zdroj: Journal of neuro-oncology [J Neurooncol] 2024 Mar; Vol. 167 (1), pp. 133-144. Date of Electronic Publication: 2024 Feb 07.
DOI: 10.1007/s11060-024-04585-7
Abstrakt: Background: Isocitrate dehydrogenase (IDH)1/2 wildtype (wt) astrocytomas formerly classified as WHO grade II or III have significantly shorter PFS and OS than IDH mutated WHO grade 2 and 3 gliomas leading to a classification as CNS WHO grade 4. It is the aim of this study to evaluate differences in the treatment-related clinical course of these tumors as they are largely unknown.
Methods: Patients undergoing surgery (between 2016-2019 in six neurosurgical departments) for a histologically diagnosed WHO grade 2-3 IDH1/2-wt astrocytoma were retrospectively reviewed to assess progression free survival (PFS), overall survival (OS), and prognostic factors.
Results: This multi-center study included 157 patients (mean age 58 years (20-87 years); with 36.9% females). The predominant histology was anaplastic astrocytoma WHO grade 3 (78.3%), followed by diffuse astrocytoma WHO grade 2 (21.7%). Gross total resection (GTR) was achieved in 37.6%, subtotal resection (STR) in 28.7%, and biopsy was performed in 33.8%. The median PFS (12.5 months) and OS (27.0 months) did not differ between WHO grades. Both, GTR and STR significantly increased PFS (P < 0.01) and OS (P < 0.001) compared to biopsy. Treatment according to Stupp protocol was not associated with longer OS or PFS compared to chemotherapy or radiotherapy alone. EGFR amplification (P = 0.014) and TERT-promotor mutation (P = 0.042) were associated with shortened OS. MGMT-promoter methylation had no influence on treatment response.
Conclusions: WHO grade 2 and 3 IDH1/2 wt astrocytomas, treated according to the same treatment protocols, have a similar OS. Age, extent of resection, and strong EGFR expression were the most important treatment related prognostic factors.
(© 2024. The Author(s).)
Databáze: MEDLINE
Externí odkaz: