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Acta Neuropathologica
Published in: Acta Neuropathologica 6/2015

01-06-2015 | Original Paper

IDH mutant diffuse and anaplastic astrocytomas have similar age at presentation and little difference in survival: a grading problem for WHO

Authors: David E. Reuss, Yasin Mamatjan, Daniel Schrimpf, David Capper, Volker Hovestadt, Annekathrin Kratz, Felix Sahm, Christian Koelsche, Andrey Korshunov, Adriana Olar, Christian Hartmann, Jaap C. Reijneveld, Pieter Wesseling, Andreas Unterberg, Michael Platten, Wolfgang Wick, Christel Herold-Mende, Kenneth Aldape, Andreas von Deimling

Published in: Acta Neuropathologica | Issue 6/2015

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Abstract

The WHO 2007 classification of tumors of the CNS distinguishes between diffuse astrocytoma WHO grade II (A IIWHO2007) and anaplastic astrocytoma WHO grade III (AA III WHO2007). Patients with A II WHO2007 are significantly younger and survive significantly longer than those with AA III WHO2007. So far, classification and grading relies on morphological grounds only and does not yet take into account IDH status, a molecular marker of prognostic relevance. We here demonstrate that WHO 2007 grading performs poorly in predicting prognosis when applied to astrocytoma carrying IDH mutations. Three independent series including a total of 1360 adult diffuse astrocytic gliomas with IDH mutation containing 683 A II IDHmut, 562 AA III IDHmut and 115 GBM IDHmut have been examined for age distribution and survival. In all three series patients with A II IDHmut and AA III IDHmut were of identical age at presentation of disease (36–37 years) and the difference in survival between grades was much less (10.9 years for A II IDHmut, 9.3 years for AA III IDHmut) than that reported for A II WHO2007 versus AA III WHO2007. Our analyses imply that the differences in age and survival between A II WHO2007 and AA III WHO2007 predominantly depend on the fraction of IDH-non-mutant astrocytomas in the cohort. This data poses a substantial challenge for the current practice of astrocytoma grading and risk stratification and is likely to have far-reaching consequences on the management of patients with IDH-mutant astrocytoma.
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Metadata
Title
IDH mutant diffuse and anaplastic astrocytomas have similar age at presentation and little difference in survival: a grading problem for WHO
Authors
David E. Reuss
Yasin Mamatjan
Daniel Schrimpf
David Capper
Volker Hovestadt
Annekathrin Kratz
Felix Sahm
Christian Koelsche
Andrey Korshunov
Adriana Olar
Christian Hartmann
Jaap C. Reijneveld
Pieter Wesseling
Andreas Unterberg
Michael Platten
Wolfgang Wick
Christel Herold-Mende
Kenneth Aldape
Andreas von Deimling
Publication date
01-06-2015
Publisher
Springer Berlin Heidelberg
Published in
Acta Neuropathologica / Issue 6/2015
Print ISSN: 0001-6322
Electronic ISSN: 1432-0533
DOI
https://doi.org/10.1007/s00401-015-1438-8

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