Abstract
BackgroundCurrent 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.MethodsWe 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.ResultsOn 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.ConclusionsOur 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.
Highlights
Current guidelines for the treatment of anaplastic astrocytoma (AA) recommend maximal safe resection followed by radiotherapy and chemotherapy
The results demonstrated that concomitant TMZ did not increase overall survival (OS) in the entire study cohort, though a trend towards benefit was present in isocitrate dehydrogenase (IDH)-mutant tumors [7]
One patient was treated in line with the Nordic glioma regimen and received hypofractionated treatment with 34 Gy in 10 fractions of 3.4 Gy [14]
Summary
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. As our knowledge of molecular markers has rapidly evolved, studies performed before the 2016 WHO classification update did not distinguish between the separate entities, as we currently do. In the NOA-04 study, molecular subgroup analysis of a mixed cohort of patients with WHO grade III tumors demonstrated associations of IDH mutations, 1p/19q-codeletion, and O6-methylguanine-DNA-methyltransferase (MGMT) promoter methylation with better progression-free survival (PFS) and overall survival (OS). Together with a young age, a high initial Karnofsky Performance Status (KPS) and the presence of oligodendroglial histological characteristics are generally the most important factors associated with better outcomes of WHO grade III gliomas [2]
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