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Abstract
Introduction. Despite an initially indolent clinical course, all low-grade gliomas (LGG, grade 2) inevitably undergo malignant transformation (MT) to higher grades (grade 3 or 4) over time.
Aim. To identify factors predictive of malignant transformation in LGG.
Materials and Methods. 116 patients with supratentorial LGG underwent surgery. All cases harbored confirmed IDH1/2 (100 %) mutations, and 69 (59.5%) were tested for 1p/19q codeletion. Disease relapse occurred in 47 patients (40,5 %; 47/116). The review according to WHO 2021 criteria was performed on tis-sue from both the surgeries, supplemented by immunohistochemistry (Ki-67, IDH1(R132H), GFAP, p53) and molecular testing (real-time PCR for IDH1/2 and TP53). 1p/19q status was assessed by fluorescence in situ hybridization (FISH) and PCR in all relapsed cases (100 %; 47/47).
Results. Among the 47 (40.5 %; 47/116) patients with disease progression, 32 (68%) had IDH-mutant astrocytoma grade 2 and 15 (32%) had IDH-mutant, 1p/19q-codeleted oligodendroglioma (ODG) grade 2. The rate of malignant transformation was 19% higher in astrocytoma than in ODG (65.6%; 21/32 vs. 46.6%; 7/15). Factors significantly associated with earlier relapse and MT were: Karnofsky Performance Status < 70% (p= 0.034), tumor growth rate ≥ 5 mm/year (p= 0.04), maximum tumor diameter ≥ 5 cm (p= 0.031), tumor volume ≥ 100 cm³ (p= 0.008), involvement of the subventricular zone (p= 0.041), and presence of TP53 mutation (p= 0.035). Factors associated with longer time to progression and MT (protective effects) were: preoperative epileptic seizures (p= 0.02), circumscribed tumor growth pattern (p= 0.039), extent of resection > 90% (p= 0.018), presence of 1p/19q codeletion (p= 0.014), and adjuvant therapy (RT, CT, or both) after initial surgery (p< 0.05).
Conclusion. Malignant transformation with the onset of relapse in patients with astrocytoma grade 2 is 19 % more common compared to ODG grade 2 (65.6 vs 46.6 %). Factors that had a greater impact on the frequency of MT were identified.
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