Publication Date:
2013-03-26
Description:
Background Low-grade gliomas (LGGs) are rare brain neoplasms, with survival spanning up to a few decades. Thus, accurate evaluations on how biomarkers impact survival among patients with LGG require long-term studies on samples prospectively collected over a long period. Methods The 210 adult LGGs collected in our databank were screened for IDH1 and IDH2 mutations ( IDH mut), MGMT gene promoter methylation ( MGMT met), 1p/19q loss of heterozygosity (1p19qloh), and nuclear TP53 immunopositivity (TP53pos). Multivariate survival analyses with multiple imputation of missing data were performed using either histopathology or molecular markers. Both models were compared using Akaike's information criterion (AIC). The molecular model was reduced by stepwise model selection to filter out the most critical predictors. A third model was generated to assess for various marker combinations. Results Molecular parameters were better survival predictors than histology (AIC = 12.5, P 〈 .001). Forty-five percent of studied patients died. MGMT met was positively associated with IDH mut ( P 〈 .001). In the molecular model with marker combinations, IDH mut/ MGMT met combined status had a favorable impact on overall survival, compared with IDH wt (hazard ratio [HR] = 0.33, P 〈 .01), and even more so the triple combination, IDH mut/ MGMT met/1p19qloh (HR = 0.18, P 〈 .001). Furthermore, IDH mut/ MGMT met/TP53pos triple combination was a significant risk factor for malignant transformation (HR = 2.75, P 〈 .05). Conclusion By integrating networks of activated molecular glioma pathways, the model based on genotype better predicts prognosis than histology and, therefore, provides a more reliable tool for standardizing future treatment strategies.
Print ISSN:
1522-8517
Electronic ISSN:
1523-5866
Topics:
Medicine
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