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. 2024 Dec;170(3):655-664.
doi: 10.1007/s11060-024-04826-9. Epub 2024 Sep 24.

Determinants of long-term survival in patients with IDH-mutant gliomas

Sophie Katzendobler  1 , Sebastian Niedermeyer  1 , Jens Blobner  1 , Christoph Trumm  2 , Patrick N Harter  3 , Louisa von Baumgarten  1   4 , Veit M Stoecklein  1   4 , Joerg-Christian Tonn  1   4 , Michael Weller  5 , Niklas Thon #  1   4 , Jonathan Weller #  6
Affiliations

Determinants of long-term survival in patients with IDH-mutant gliomas

Sophie Katzendobler et al. J Neurooncol. 2024 Dec.

Abstract

Background: Survival times of patients with IDH-mutant gliomas are variable and can extend to decades. Many studies provide progression-free rather than overall survival times and prognostic factors remain ill-defined. Here we explored characteristics of short- and long-term survivors within a cohort of patients with extended follow-up.

Methods: This single-center, case-control study included 86 patients diagnosed between 1998 and 2023 who either died within 6 years after diagnosis or survived at least 15 years. Patient characteristics and prognostic factors were stratified by short- (< 6 years) versus long-term (≥ 15 years) survival.

Results: Forty-seven patients (55%) diagnosed with astrocytoma and 39 patients (45%) with oligodendroglioma were included retrospectively. Median follow-up of the survivors was 16.6 years (range 15-28.9). Thirty-four deaths (40%) had been reported at database closure. Long-term survival was associated with CNS WHO grade 2 (p < 0.01), smaller tumor volumes (p = 0.01), lack of contrast enhancement (p < 0.01), wait-and-scan strategies (p < 0.01) and female sex (p = 0.04). In multivariate analyses for oligodendroglioma, larger T2 tumor volumes were associated with shorter survival (HR 1.02; 95% CI 1.01-1.05; p = 0.04). In patients with astrocytoma, lack of contrast enhancement (HR 0.38; 95% CI 0.15-0.94; p = 0.04) and wait-and-scan strategies (HR 5.75; 95% CI 1.66-26.61; p = 0.01) were associated with longer survival.

Conclusion: Large T2 tumor volume and contrast enhancement may be important risk factors for shorter survival, while age might be of lesser importance. Wait-and-scan strategies may yield excellent long-term survival in some patients with astrocytoma.

Keywords: Astrocytoma; Chemotherapy; IDH-mutation; Lower grade glioma; Oligodendroglioma; Radiotherapy; Temozolomide.

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Conflict of interest statement

Declarations. Ethics approval: Ethics approval was obtained by the ethics committee of the Ludwig Maximilian University of Munich (project number 20–513 and project number 21–0612). Consent to participate: Consent to participate in retrospective studies is given prospectively by all patients treated at the Department of Neurosurgery of the Ludwig Maximilian University of Munich through a local prospective tumor registry. Consent for publication: All authors have consented in submitting this manuscript for publication in the Journal of Neuro-Oncology. Additional declarations for articles in life science journals that report the results of studies involving humans and/or animals: The present study was conducted retrospectively. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
STROBE diagram. Patients with IDH-mutant gliomas were identified and included if death had been reported within 6 years after diagnosis or if the patient had survived for at least 15 years. Patients with shorter follow-up times were excluded. *Gliomas were classified according to WHO 2021 with the limitation of not having conducted CDKN2A/B analyses. STROBE, The Strengthening the Reporting of Observational Studies in Epidemiology Statement
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