Lasica, AB;
Jaunmuktane, Z;
Fersht, N;
Kirkman, MA;
Dixon, L;
Hoskote, C;
Brandner, S;
(2021)
Genomic Prognosticators and Extent of Resection in Molecularly Subtyped World Health Organization Grade II and III Gliomas–A Single-Institution, Nine-Year Data.
World Neurosurgery
, 151
e217-e233.
10.1016/j.wneu.2021.04.026.
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Abstract
BACKGROUND: WHO grade II and III IDH wild-type (IDH-wt) gliomas are often treated as WHO grade IV glioblastomas. However, cumulative evidence indicates that IDH mutation status alone is insufficient in predicting survival. The current study examines molecular and clinical markers to further prognostically stratify WHO grade II and III gliomas, in particular, IDH-wt. METHODS: A single institution's records were retrospectively reviewed for molecularly stratified WHO grade II and grade III gliomas over a nine-year period (2010-2019). Clinical data, IDH1/IDH2 status, EGFR amplification and other molecular markers were recorded and correlated to the study outcomes. These were defined as progression-free survival (PFS), overall survival (OS) and time to malignant progression (TtMP). RESULTS: 167 and 42 WHO grade II and III gliomas, respectively, were identified, totalling 209 cases with 157 IDH1/2 mutated and 52 IDH wild-type tumours. The presence of IDH1/2 mutation was associated with longer OS (p<0.0001) and PFS (p<0.0001) but not with TtMP (p=0.314). Lack of EGFR amplification, younger age, greater extent of resection (EOR) (≥80%) were identified as independent, favourable prognostic factors. In the IDH-wt cohort, multivariate analysis indicated that older age (p=0.003) and lesser EOR (<80%) (p=0.007) are associated with worse OS. Additionally, EGFR amplification showed a trend toward shorter OS in the IDH-wt cohort (p=0.073). CONCLUSIONS: IDH1/2 mutation favours longer OS and PFS but does not protect from malignant progression. Lack of EGFR amplification, older age and greater EOR are favourable OS prognosticators. In the IDH-wt cohort, older age and lesser EOR were linked to worse OS.
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