Roberta Rudà1,2, Francesco Bruno1, Tamara Ius3, Antonio Silvani4, Giuseppe Minniti5, Andrea Pace1, Giuseppe Lombardi6, Luca Bertero7, Stefano Pizzolitto8, Bianca Pollo9, Marco Conti Nibali10, Alessia Pellerino11, Enrica Migliore12, Miran Skrap3, Lorenzo Bello8,10, Riccardo Soffietti1. 1. Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy. 2. Department of Neurology, Castelfranco Veneto and Brain Tumor Board Treviso Hospital, Italy. 3. Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy. 4. Department of Neuro-Oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 5. Radiation Oncology Unit, Department of Medicine, Surgery and Neurosciences, University Hospital, Siena, Italy. 6. Department of Oncology, Veneto Institute of Oncology, Padua, Italy. 7. Pathology Unit, Department of Medical Sciences, University of Turin, Italy. 8. Department of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy. 9. Neuropathology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. 10. Neurosurgical Oncology Division, Department of Oncology and Hemato-Oncology, University of Milan, Italy. 11. Neuro-Oncology Unit, Regina Elena National Cancer Institute, Rome, Italy. 12. Unit of Cancer Epidemiology (CPO Piemonte), University of Turin, Turin, Italy.
Abstract
BACKGROUND: Prognostic factors and role of treatments are not well known in isocitrate dehydrogenase (IDH) wild-type (wt) grade 2 astrocytomas. The aim of this study was to define in these tumors clinical features, molecular characteristics, and prognostic factors, with particular focus on molecular subgroups defined by cIMPACT-NOW update 3. METHODS: We analyzed 120 patients with confirmed diagnosis of grade 2 IDHwt astrocytoma according to WHO 2016, collected from seven Italian centers between 1999 and 2017. RESULTS: Median PFS and OS of the whole cohort were 18.9 and 32.6 months. Patients older than 40 years and patients with modest contrast enhancement on MRI had a shorter PFS and OS. Gross total resection yielded superior PFS and OS over non-gross total resection. PFS and OS of patients with either pTERT mutation or EGRF amplification were significantly shorter. The prognostic value of age, contrast enhancement on MRI, and extent of surgery was different within the molecular subgroups. Gross total resection was associated with increased PFS (not reached versus 14 months, p = 0.023) and OS (117.9 versus 20 months, p = 0.023) in patients without EGFR amplification, and with increased OS in those without pTERT mutation (NR vs 53.7 months, p = 0.05). Conversely, for patients with EGFR amplification or pTERT mutation, gross total resection did not yield a significant survival benefit. CONCLUSION: Patients without EGFR amplification and pTERT mutation could be observed after gross total resection.
BACKGROUND: Prognostic factors and role of treatments are not well known in isocitrate dehydrogenase (IDH) wild-type (wt) grade 2 astrocytomas. The aim of this study was to define in these tumors clinical features, molecular characteristics, and prognostic factors, with particular focus on molecular subgroups defined by cIMPACT-NOW update 3. METHODS: We analyzed 120 patients with confirmed diagnosis of grade 2 IDHwt astrocytoma according to WHO 2016, collected from seven Italian centers between 1999 and 2017. RESULTS: Median PFS and OS of the whole cohort were 18.9 and 32.6 months. Patients older than 40 years and patients with modest contrast enhancement on MRI had a shorter PFS and OS. Gross total resection yielded superior PFS and OS over non-gross total resection. PFS and OS of patients with either pTERT mutation or EGRF amplification were significantly shorter. The prognostic value of age, contrast enhancement on MRI, and extent of surgery was different within the molecular subgroups. Gross total resection was associated with increased PFS (not reached versus 14 months, p = 0.023) and OS (117.9 versus 20 months, p = 0.023) in patients without EGFR amplification, and with increased OS in those without pTERT mutation (NR vs 53.7 months, p = 0.05). Conversely, for patients with EGFR amplification or pTERT mutation, gross total resection did not yield a significant survival benefit. CONCLUSION: Patients without EGFR amplification and pTERT mutation could be observed after gross total resection.
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