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Vol. 28. Num. 6.November - December 2017Pages 259-310
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Vol. 28. Num. 6.November - December 2017Pages 259-310
Clinical Research
DOI: 10.1016/j.neucie.2017.07.003
Prognostic and predictive factors in high-grade gliomas. Experience at our institution
Factores pronósticos y predictivos en gliomas de alto grado. Experiencia en nuestro centro
Diana Alonsoa,
Corresponding author
dianaalonsosanchez@hotmail.com

Corresponding author.
, Manuel Matallanasa, Alba Riveros-Pérezb, Maripaz Pérez-Payoa, Sonia Blancoa
a Servicio de Oncología Radioterápica, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
b Servicio de Oncología Radioterápica, Hospital Universitario Doctor Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
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Table 1. Result as absolute number of patients with positive, negative or not assessable markers in each molecular test, taking into account their histological grade.
Table 2. Summary of the absolute number of patients with each molecular test result taking into account the 2 WHO histological grades of high-grade gliomas.
Table 3. Summary of the MGMT gene promoter methylation test result in the sub-group of patients with grade IV gliomas.
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Abstract
Objective

To describe and analyse predictive and prognostic factors of overall survival (OS) in high-grade gliomas at our institution.

Material and method

All patients diagnosed with grade III (GIII) or grade IV (GIV) gliomas (excluding oligodendrogliomas, oligoastrocytomas or infratentorial gliomas) were prospectively included from November 2010 to August 2014. All were treated with surgery followed by adjuvant radiochemotherapy. The Kaplan–Meier method was used for the statistical analysis, considering a p value <0.05 to be significant.

Results

89 patients were studied (18 GIII and 71 GIV). The average age was 60 years and 55% were men. The mean Karnofsky score was 80%. The most common location was the frontal lobe (38%). A total of 65% were partial resections. Complete chemotherapy was administered to 74% and complete RT to 83% of patients. Mean OS was 26.8±8.3 months for GIII and 12.5±1 month for GIV. 72 had died by the end of this study. A total of 40% of patients had MGMT methylation, 7% IDH1 mutation and 47% EGFR amplification. Statistically significant variables for OS were: GIII (p=0.020), age <70 years (p=0.040), <65 years (p=0.013) and <60 years (p=0.003), Karnofsky70% (p=0.029), complete radiotherapy (p=0.000), complete resection (p=0.001), MGMT methylation (p=0.042), IDH1 mutation (p=0.007) and EGFR non-amplification (p=0.034). Additionally, GIII and GIV subgroups were independently analysed. In GIII, the only significant biomarker for OS was IDH1 mutation, while in GIV, MGMT methylation (p=0.023) was significant. Age ≥70 years old was a significant factor in the GIII-subgroup (p=0.040) but not for GIV (p=0.166).

Conclusions

Data are in line with previous studies, with the exception of age, which does not appear to be significant in GIV.

Keywords:
Glioma
Glioblastoma
Astrocytoma
Resumen
Objetivo

Describir y analizar los factores predictivos y pronósticos en gliomas de alto grado respecto a supervivencia global (SG) en nuestro centro.

Material y método

Desde noviembre drl 2010 hasta agosto del 2014 se incluyó prospectivamente a todos los pacientes diagnosticados de glioma grado III (GIII) o IV (GIV), excepto oligodendrogliomas, oligoastrocitomas e infratentoriales. Todos se trataron con cirugía y quimioradioterapia adyuvante. Análisis estadístico mediante el método de Kaplan-Meier considerando significativo un valor de p<0,05.

Resultados

Se estudió a 89 pacientes (18 GIII y 71 GIV). Edad media=60 años; el 55% hombres. El Karnofsky medio fue del 80%. La localización más frecuente (38%) fue frontal. El 65% realizó resección parcial. Se administró quimioterapia completa al 74% y radioterapia completa al 83%. La media de SG fue 26,8±8,3 meses en GIII y 12,5±1 mes en GIV; 72 habían fallecido al terminar el estudio. El 40% de los pacientes tenía MGMT-metilada, el 7% IDH1-mutado y el 47% EGFR-amplificado. Las variables estadísticamente significativas para SG fueron: GIII (p=0,020), edad < 70 (p=0,040), < 65 (p=0,013) y < 60 años (p=0,003), Karnofsky ≥ 70% (p=0,029), resección total (p=0,001), radioterapia completa (p=0,000), MGMT-metilada (p=0,042), IDH1-mutado (p=0,007) y EGFR-no amplificado (p=0,034). Los subgrupos GIII y GIV fueron analizados de manera independiente. En el GIII, el único biomarcador significativo para la SG fue IDH1-mutado y en el GIV la MGMT-metilada (p=0,023). La edad ≥ 70 años es significativa en el GIII (p=0,040) pero no para el GIV (p=0,166).

Conclusiones

Los datos están en la línea de estudios anteriores, salvo la edad, que parece no decisiva en el GIV.

Palabras clave:
Glioma
Glioblastoma
Astrocitoma

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