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. 2025 Oct 14;27(9):2382-2398.
doi: 10.1093/neuonc/noaf133.

Clinical, molecular, and radiological predictors of prognosis in newly diagnosed astrocytoma, IDH-mutant, WHO grade 4

Aleksandra B Lasica  1   2 , Zhou Lan  3   1 , Julie J Miller  4   1 , Albert Jiao  5 , Ian Pan  5 , Loai Aker  5 , Prem Prabhakar  6 , Julia Japo  6 , Alyssa Russ  2 , Catharina Westergaard  2 , Elisa Aquilanti  1   2 , Ugonma Chukwueke  1   2 , L Nicolas Gonzalez Castro  7   1   2 , J Ricardo McFaline Figueroa  8   9 , Eudocia Quant Lee  1   2 , Lakshmi Nayak  1   2 , Rameen Beroukhim  1   2 , Tracy T Batchelor  7   1 , Daniel P Cahill  10   1 , Vihang Nakhate  4   1   2 , Tyler Lanman  4   1   2 , Juan Pablo Ospina  4   1   2 , Natalie Stec  4   1   2 , Ruchit V Patel  10   1 , David M Meredith  6   1 , Wenya Linda Bi  10   1 , David A Reardon  1   2 , Keith L Ligon  6   1 , Raymond Y Huang  5   1 , Patrick Y Wen  1   2 , Gilbert Youssef  1   2
Affiliations

Clinical, molecular, and radiological predictors of prognosis in newly diagnosed astrocytoma, IDH-mutant, WHO grade 4

Aleksandra B Lasica et al. Neuro Oncol. .

Abstract

Background: Astrocytoma, isocitrate dehydrogenase-mutant, WHO grade 4 (Astro4), is a new tumor type in the 2021 WHO classification of central nervous system tumors that has been poorly characterized in the literature. This study evaluates predictors of prognosis in a large cohort of newly diagnosed Astro4.

Methods: We retrospectively identified 128 consecutive adult patients who presented with an initial diagnosis of Astro4 at Dana-Farber Cancer Institute and Massachusetts General Hospital between 2010 and 2021. Clinical, molecular, and radiological characteristics were recorded, and their associations with overall survival (OS) and progression-free survival (PFS) were measured by log-rank test and Cox proportional hazards model.

Results: The median age at diagnosis was 37.1 years, and 61.7% were men. The median OS was 5.9 years (95% confidence interval, 4.4-7.3), while the median PFS was 2.7 years (1.8 -3.6). Age ≥ 50 and homozygous CDKN2A/B deletion were independent negative prognosticators of OS on univariate and multivariate analyses (hazard ratio [HR], 2.21 [1.16-4.21], P = .019; HR, 2.61 [1.27-5.38], P = .013). Maximal resection of enhancing disease was associated with longer PFS on univariate and multivariate analyses (HR, 0.48 [0.26-0.87], P = .019). There were no significant differences in OS or PFS based on MGMT promoter methylation status, T2/FLAIR extent of resection, T2/FLAIR mismatch, radiological pseudoprogression, or enhancement on the pre-operative scan.

Conclusions: Our study comprehensively characterizes a large cohort of newly diagnosed patients with Astro4, emphasizing the prognostic value of CDKN2A/B deletion, age, and the extent of resection of enhancing disease in these patients.

Keywords: CDKN2A/B deletion; IDH-mutant; WHO Grade 4; astrocytoma; prognosis.

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References

    1. Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021; 23(8):1231–1251. - PMC - PubMed
    1. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system [published correction appears in Acta Neuropathol. 2007 Nov;114(5):547]. Acta Neuropathol. 2007; 114(2):97–109. - PMC - PubMed
    1. Louis DN, Perry A, Reifenberger G, et al. The 2016 world health organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016; 131(6):803–820. - PubMed
    1. Parsons DW, Jones S, Zhang X, et al. An integrated genomic analysis of human glioblastoma multiforme. Science. 2008; 321(5897):1807–1812. - PMC - PubMed
    1. Ostrom QT, Shoaf ML, Cioffi G, et al. National-level overall survival patterns for molecularly-defined diffuse glioma types in the United States. Neuro Oncol. 2023; 25(4):799–807. - PMC - PubMed

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