Predicting survival in anaplastic astrocytoma patients in a single-center cohort of 108 patients
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RESEARCH
Predicting survival in anaplastic astrocytoma patients in a single‑center cohort of 108 patients Helena C. W. Wahner1, Malte Träger1, Katja Bender1, Leonille Schweizer2,3, Julia Onken4, Carolin Senger1, Felix Ehret1, Volker Budach1 and David Kaul1,3*
Abstract Background: Current guidelines for the treatment of anaplastic astrocytoma (AA) recommend maximal safe resection followed by radiotherapy and chemotherapy. Despite this multimodal treatment approach, patients have a limited life expectancy. In the present study, we identified variables associated with overall survival (OS) and constructed a model score to predict the OS of patients with AA at the time of their primary diagnosis. Methods: We retrospectively evaluated 108 patients with newly diagnosed AA. The patient and tumor characteristics were analyzed for their impact on OS. Variables significantly associated with OS on multivariable analysis were included in our score. The final algorithm was based on the 36-month survival rates corresponding to each characteristic. Results: On univariate analysis, age, Karnofsky performance status, isocitrate dehydrogenase status, and extent of resection were significantly associated with OS. On multivariable analysis all four variables remained significant and were consequently incorporated in the score. The total score ranges from 20 to 33 points. We designated three prognostic groups: A (20–25), B (26–29), and C (30–33 points) with 36-month OS rates of 23%, 71%, and 100%, respectively. The OS rate at 5 years was 8% in group A, 61% in group B and 88% in group C. Conclusions: Our model score predicts the OS of patients newly diagnosed with AA and distinguishes patients with a poor survival prognosis from those with a greater life expectancy. Independent and prospective validation is needed. The upcoming changes of the WHO classification of brain tumors as well as the practice changing results from the CATNON trial will most likely require adaption of the score. Keywords: Score, Anaplastic astrocytoma, Overall survival, Glioma Background Anaplastic astrocytoma (AA) is a diffusely infiltrating, malignant primary brain tumor. An update of the World Health Organization (WHO) classification in 2016 established new diagnostic groups based on histological phenotypes and genotypes, which are linked to unique *Correspondence: [email protected] 1 Department of Radiation Oncology, Charité University Hospital Berlin, Augustenburger Platz 1, 13353 Berlin, Germany Full list of author information is available at the end of the article
biological behaviors and treatment responses [1]. WHO grade III tumors are distinguished in case of oligodendroglioma and AA. They differ in their molecular profiles, and patients have a distinct median age at diagnosis and median survival. Oligodendrogliomas typically present with 1p/19q-codeletion combined with IDH-mutation and have the best outcome of all WHO grade III tumors. AA can be further differentiated into subgroups based on isocitrate dehydrogenase (IDH) type
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