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000303080 041__ $$aEnglish
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000303080 1001_ $$aBlobner, Jens$$b0
000303080 245__ $$aClinical and neuropathological criteria for distinguishing between IDH-mutant astrocytomas of WHO grade 2 and 3.
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000303080 520__ $$aThe 2021 WHO classification of CNS tumors allows flexibility in the grading of IDH-mutant astrocytic gliomas, leading to some ambiguity. Following the approval of vorasidenib for WHO grade 2 astrocytomas and oligodendrogliomas based on the positive Phase III INDIGO trial, identifying prognostic criteria to differentiate between grade 2 and grade 3 tumors has become increasingly important.We retrospectively searched our institutional database for patients meeting the diagnostic criteria for IDH-mutant astrocytomas (grade 2 and 3) according to the WHO 2021 classification. Clinical, radiological and molecular data were collected; outcome was compared using log-rank analysis and prognostic markers were subsequently forwarded in a multivariate model.We identified 91 patients with IDH-mutant astrocytomas with available neuropathological and clinical data, including 61 WHO grade 2 (67.0%) and 30 WHO grade 3 (33.0%) tumors. At a median follow-up of 89 months, median progression-free survival was 67 months for WHO grade 2 and 53 months for WHO grade 3 tumors. Median overall survival was 216 months for WHO grade 3 tumors, while it was not reached for WHO grade 2 tumors. Univariate analysis showed that higher WHO grade, increased mitotic count, elevated Ki67 indices and preoperative contrast enhancement were associated with poorer outcomes; however, only contrast enhancement retained prognostic significance on multivariate analysis (p = 0.03 for overall survival, p = 0.02 for progression-free survival).While our findings await confirmation in larger prospective cohorts, neuropathological grading criteria might need to be accompanied by clinical information including contrast enhancement to prognostically distinguish grade 2 from grade 3 tumors.
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000303080 650_7 $$2Other$$aAstrocytoma
000303080 650_7 $$2Other$$aContrast-enhancement
000303080 650_7 $$2Other$$aGrading
000303080 650_7 $$2Other$$aIDH-inhibitor
000303080 650_7 $$2Other$$aIDH-mutant
000303080 650_7 $$2Other$$aMitotic count
000303080 7001_ $$aRuf, Viktoria$$b1
000303080 7001_ $$aWeller, Jonathan$$b2
000303080 7001_ $$aTeske, Nico$$b3
000303080 7001_ $$aForbrig, Robert$$b4
000303080 7001_ $$aThon, Niklas$$b5
000303080 7001_ $$aAlbert, Nathalie L$$b6
000303080 7001_ $$0P:(DE-HGF)0$$avon Baumgarten, Louisa$$b7
000303080 7001_ $$aSchoenecker, Stephan$$b8
000303080 7001_ $$aTonn, Joerg-Christian$$b9
000303080 7001_ $$aRingel, Florian$$b10
000303080 7001_ $$0P:(DE-He78)b15b56a6ed37417d476470c60c0140ff$$aHarter, Patrick$$b11
000303080 7001_ $$aKarschnia, Philipp$$b12
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