Risk factors for the development of an early recurrence of gemistocytic astrocytomas and their clinical significance

Abstract

Introduction. According to the WHO CNS of tumors of central nervous system gemistocytic astrocytomas (GA) are common astrocytic tumors, in which the proportion of gemistocytes is at least 20 % of the total cell mass. Morpho-molecular characterization and treatment tactics of GA research is insufficient.Purpose. Identification of risk factors for the development of early recurrence of gemistocytic astrocytes (GA).Material and methods. A retrospective and prospective analysis of the identified signs, brain MRI data, features of morphological and molecular genetic diseases was performed in 14 patients diagnosed with GA. The work included patients older than 18 years with supratentorial invasive tumor. The patients were aged 27 to 62 years, the average temperature of the age was 35.5 years. There were 5 men. After the removal operation, histological, immunohistochemical and molecular genetic studies were performed. The histological diagnosis was made according to the WHO classification of CNS tumors and the AFIP atlas (2007). Real-time PCR revealed the presence of mutations in the IDH1/IDH2 genes and the combined deletion of 1p19q in all patients; in 10 patients, the level of gene expression was also observed: TP, VEGF, PDGFRA, β-tubulin, MGMT, C-kit, ERCC1.Results. Median recurrence-free period (RFS) GA was 89 weeks. If a recurrence occurs before this time RFS is considered early. The odds ratio (OR) was calculated for different groups of early and late recurrence according to the standard method. Significantly, the risk of developing an early relapse of GA increased with the expression of the VEGF gene, ΔSt < 1.15 (p < 0.05) (OR — 121). Several risk factors were also identified that cause inflammation of GA recurrence, but without a statistical tumor: expression of the β-tubulin gene ΔSt < 0.65 (RR — 33), accumulation of tumor contrast. according to MRI of the brain (OR — 10.7), vascular proliferation (OR — 8.3), Ki-67 > 5 % (OR — 4.5), tumor spread in the area of opening of the cerebral hemispheres (OR — 4.5).Conclusion. Features of brain MRI data, morphological and molecular-genetic picture These patients probably need complex treatment (surgery, radiation therapy, chemotherapy), which they currently do not meet.