Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan;16(1):81-91.
doi: 10.1093/neuonc/not159. Epub 2013 Dec 4.

IDH1 mutant malignant astrocytomas are more amenable to surgical resection and have a survival benefit associated with maximal surgical resection

Jason Beiko  1 , Dima Suki, Kenneth R Hess, Benjamin D Fox, Vincent Cheung, Matthew Cabral, Nicole Shonka, Mark R Gilbert, Raymond Sawaya, Sujit S Prabhu, Jeffrey Weinberg, Frederick F Lang, Kenneth D Aldape, Erik P Sulman, Ganesh Rao, Ian E McCutcheon, Daniel P Cahill
Affiliations

IDH1 mutant malignant astrocytomas are more amenable to surgical resection and have a survival benefit associated with maximal surgical resection

Jason Beiko et al. Neuro Oncol. 2014 Jan.

Abstract

Background: IDH1 gene mutations identify gliomas with a distinct molecular evolutionary origin. We sought to determine the impact of surgical resection on survival after controlling for IDH1 status in malignant astrocytomas-World Health Organization grade III anaplastic astrocytomas and grade IV glioblastoma.

Methods: Clinical parameters including volumetric assessment of preoperative and postoperative MRI were recorded prospectively on 335 malignant astrocytoma patients: n = 128 anaplastic astrocytomas and n = 207 glioblastoma. IDH1 status was assessed by sequencing and immunohistochemistry.

Results: IDH1 mutation was independently associated with complete resection of enhancing disease (93% complete resections among mutants vs 67% among wild-type, P < .001), indicating IDH1 mutant gliomas were more amenable to resection. The impact of residual tumor on survival differed between IDH1 wild-type and mutant tumors. Complete resection of enhancing disease among IDH1 wild-type tumors was associated with a median survival of 19.6 months versus 10.7 months for incomplete resection; however, no survival benefit was observed in association with further resection of nonenhancing disease (minimization of total tumor volume). In contrast, IDH1 mutants displayed an additional survival benefit associated with maximal resection of total tumor volume (median survival 9.75 y for >5 cc residual vs not reached for <5 cc, P = .025).

Conclusions: The survival benefit associated with surgical resection differs based on IDH1 genotype in malignant astrocytic gliomas. Therapeutic benefit from maximal surgical resection, including both enhancing and nonenhancing tumor, may contribute to the better prognosis observed in the IDH1 mutant subgroup. Thus, individualized surgical strategies for malignant astrocytoma may be considered based on IDH1 status.

Keywords: IDH1; anaplastic astrocytoma; glioblastoma; malignant glioma; surgical resection.

PubMed Disclaimer

Figures

Fig. 1.
Fig. 1.
Kaplan–Meier estimates of IDH1 wild-type malignant astrocytoma overall survival according to (A) presence or absence of postoperative enhancing disease and (B) presence or absence of postoperative total disease volume (enhancing and nonenhancing). IDH1 wild-type malignant astrocytomas (AA and GBM) display an improved survival in association with resection of enhancing disease, but not minimization of overall tumor volume (enhancing and nonenhancing).
Fig. 2.
Fig. 2.
Kaplan–Meier estimates of IDH1 mutant malignant astrocytoma overall survival according to presence or absence of postoperative total disease volume (enhancing and nonenhancing). IDH1 mutant malignant astrocytomas (AA and GBM) display an improved survival in association with minimization of overall tumor volume (enhancing and nonenhancing). Importantly, no “cutoff” value was apparent within the continuous volumetric data.
See this image and copyright information in PMC

Comment in

References

    1. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97–109. - PMC - PubMed
    1. Glantz MJ, Burger PC, Herndon JE, 2nd, et al. Influence of the type of surgery on the histologic diagnosis in patients with anaplastic gliomas. Neurology. 1991;41(11):1741–1744. - PubMed
    1. Nobusawa S, Watanabe T, Kleihues P, Ohgaki H. IDH1 mutations as molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res. 2009;15(19):6002–6007. - PubMed
    1. Prayson RA, Agamanolis DP, Cohen ML, et al. Interobserver reproducibility among neuropathologists and surgical pathologists in fibrillary astrocytoma grading. J Neurol Sci. 2000;175(1):33–39. - PubMed
    1. Bettegowda C, Agrawal N, Jiao Y, et al. Mutations in CIC and FUBP1 contribute to human oligodendroglioma. Science. 2011;333(6048):1453–1455. - PMC - PubMed

Publication types

MeSH terms

Substances