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Original Article | Open Access

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

Yanwei Liu1,2,*, Huiyuan Chen2,3,*, Guanzhang Li2,4, Jing Zhang1,2, Kun Yao5, Chenxing Wu6, Shouwei Li6, Xiaoguang Qiu1,2 ( )
Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
National Clinical Research Center for Neurological Diseases, Beijing 100070, China
Department of Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Department of Neuropathology, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing 100093, China

*These authors contributed equally to this work.

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Abstract

Objective

IDH-mutant lower-grade gliomas (LGGs, grade 2 or 3) eventually transform into secondary grade 4 astrocytomas (sAIDHmut/G4). Here, we sought to describe the transformation time, risk factors, and outcomes in malignant transformation of IDH-mutant LGGs.

Methods

We screened data for 108 patients with sAIDHmut/G4 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 sAIDHmut/G4, and associated risk factors and outcomes. Malignant transformation was defined as pathological confirmation of grade 4 astrocytoma.

Results

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; P = 0.001] and non-A blood type (HR, 0.37; 95% CI, 0.203–0.680; P = 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; P = 0.008), overall survival (HR, 0.50; 95% CI, 0.265–0.972; P = 0.041), and progression-free survival (HR, 0.25; 95% CI, 0.133–0.479; P < 0.0001) in patients with IDH-mutant gliomas.

Conclusions

Radiotherapy is associated with delayed malignant transformation and improved survival in patients with IDH-mutant gliomas.

Keywords

radiotherapysurvivalmalignant transformationLower-grade gliomasIDH mutation

Electronic Supplementary Material

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Cancer Biology & Medicine
Volume 19 Issue 10,
October 2022
Pages 1477-1486
DOI: 10.20892/j.issn.2095-3941.2022.0472
Cite this article:
Liu Y, Chen H, Li G, et al. Radiotherapy delays malignant transformation and prolongs survival in patients with IDH-mutant gliomas. Cancer Biology & Medicine, 2022, 19(10): 1477-1486. https://doi.org/10.20892/j.issn.2095-3941.2022.0472

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Received: 06 August 2022
Accepted: 20 September 2022
Published: 03 November 2022
©2022 Cancer Biology & Medicine.

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