Radiotherapy delays malignant transformation and prolongs survival in patients with IDH-mutant gliomas

• Published in: Cancer biology & medicine Vol. 19; no. 10; pp. 1477 - 1486
• Main Authors: Liu, Yanwei, Chen, Huiyuan, Li, Guanzhang, Zhang, Jing, Yao, Kun, Wu, Chenxing, Li, Shouwei, Qiu, Xiaoguang
• Format: Journal Article
• Language: English
• Published: China Department of Neuropathology,Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China%National Clinical Research Center for Neurological Diseases,Beijing 100070,China 01.11.2022; Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China%Department of Neuropathology%Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China; National Clinical Research Center for Neurological Diseases,Beijing 100070,China%National Clinical Research Center for Neurological Diseases,Beijing 100070,China; Department of Radiation Oncology,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China; Compuscript; China Anti-Cancer Association
• Subjects: Adult; Astrocytoma - genetics; Astrocytoma - radiotherapy; Astrocytoma - surgery; Brain Neoplasms - genetics; Brain Neoplasms - pathology; Brain Neoplasms - radiotherapy; Cell Transformation, Neoplastic - genetics; Glioblastoma; Glioma - genetics; Glioma - pathology; Glioma - radiotherapy; Humans; idh mutation; Isocitrate Dehydrogenase - genetics; lower-grade gliomas; malignant transformation; Middle Aged; Oligodendroglioma; Original; radiotherapy; survival; Young Adult; radiotherapy; IDH mutation; Lower-grade gliomas; malignant transformation; survival
• ISSN: 2095-3941
• DOI: 10.20892/j.issn.2095-3941.2022.0472

IDH-mutant lower-grade gliomas (LGGs, grade 2 or 3) eventually transform into secondary grade 4 astrocytomas (sA ). Here, we sought to describe the transformation time, risk factors, and outcomes in malignant transformation of IDH-mutant LGGs. We screened data for 108 patients with sA in the Chinese Glioma Genome Atlas who had initial IDH-mutant LGGs and underwent reoperation during 2005-2021. We evaluated the transformation time from IDH-mutant LGGs to sA , and associated risk factors and outcomes. Malignant transformation was defined as pathological confirmation of grade 4 astrocytoma. The median age of the 108 patients with IDH-mutant LGGs was 35 years (range, 19-54); the median age at transformation was 40 years (range, 25-62); and the median follow-up time for all patients was 146 months (range, 121-171). The average transformation time was 58.8 months for all patients with LGGs (range, 5.9-208.1); 63.5 and 51.9 months for grade 2 and 3 gliomas, respectively; and 58.4 and 78.1 months for IDH-mutant/1p/19q-non-codeleted astrocytomas and IDH-mutant/1p/19q-codeleted oligodendrogliomas, respectively. Univariate and multivariate analysis indicated that radiotherapy [hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.137-0.595; = 0.001] and non-A blood type (HR, 0.37; 95% CI, 0.203-0.680; = 0.001) were protective factors against delayed malignant transformation. Radiotherapy was associated with improved survival after transformation (HR, 0.44; 95% CI, 0.241-0.803; = 0.008), overall survival (HR, 0.50; 95% CI, 0.265-0.972; = 0.041), and progression-free survival (HR, 0.25; 95% CI, 0.133-0.479; < 0.0001) in patients with IDH-mutant gliomas. Radiotherapy is associated with delayed malignant transformation and improved survival in patients with IDH-mutant gliomas.