Extent of resection and molecular pathologic subtype are potent prognostic factors of adult WHO grade II glioma

Abstract

We evaluated prognostic factors of adult low-grade glioma (LGG) according to the new 2016 WHO classification. Records of 153 patients diagnosed with WHO grade II LGG between 2003 and 2015 were retrospectively reviewed. Based on the 2016 WHO classification, 80 patients (52.3%) had diffuse astrocytoma, IDH-mutant; 45 (29.4%) had oligodendroglioma, IDH-mutant and 1p/19q-codeleted (ODG); and 28 (18.3%) had diffuse astrocytoma, IDH-wildtype. Gross total resection (GTR) was performed in 71 patients (46.4%), subtotal resection in 31 (20.3%), partial resection in 43 (28.1%), and biopsy in 8 (5.2%). One hundred two patients (66.7%) received postoperative radiotherapy. The 5- and 10-year progression-free survival (PFS) rates were 72.7% and 51.5%, respectively, and the 5- and 10-year overall survival (OS) rates were 82.5% and 63.5%, respectively. GTR and IDH-mutant and/or 1p/19q codeletion were favorable prognostic factors for PFS and OS. Patients with IDH-wildtype had significantly decreased OS. Among patients with ODG who underwent GTR, no recurrence was observed after radiotherapy. Patients who underwent non-GTR frequently experienced recurrence after radiotherapy (IDH-mutant: 47.6%, IDH-wildtype: 57.9%). In conclusion, molecular classification of LGG was of prognostic relevance, with IDH-wildtype patients having a particularly poor outcome, regardless of the treatment. Favorable results were observed in patients who underwent GTR.

Figure 1

Patients’ distribution from histopathologic subtypes to molecular subtypes according to the new 2016 WHO classification.

Figure 2

Overall survival (a) and progression-free survival (b) according to molecular subtype.

Figure 3

Comparison of overall survival in all patients and each molecular subtype by extent of resection. (a) Overall, (b) ODG, (c) IDHmt, (d) IDHwt. ODG: oligodendroglioma, isocitrate dehydrogenase-mutant and 1p/19q codeleted; IDHmt: diffuse astrocytoma, isocitrate dehydrogenase-mutant; IDHwt: diffuse astrocytoma, isocitrate dehydrogenase-wild-type.

Figure 4

Analysis of progression-free survival according to extent of resection and use of radiotherapy in each molecular subtype. (a) ODG, (b) IDHmt, (c) IDHwt. *Means statistically significant difference in the two groups. ODG: oligodendroglioma, isocitrate dehydrogenase-mutant and 1p/19q codeleted; IDHmt: diffuse astrocytoma, isocitrate dehydrogenase-mutant; IDHwt: diffuse astrocytoma, isocitrate dehydrogenase-wild-type.