Overview of prognostic factors in adult glioma; a 10-year experience at a single institution

Abstract

Objective: The most prevalent central nervous system (CNS) neoplasm arising from glial cells is glioma, which diffusely invades brain tissue. Among gliomas, Glioblastoma (GBM) is a glioma of the highest grade and associated with a grim prognosis, with a median overall survival of 15 months with and 3-4 months without therapy. We examined how clinical variables and molecular profiles may have affected overall survival (OS) at Sina Hospital in Tehran over the past ten years. Methods: A retrospective study was conducted at Sina Hospital in Tehran, Iran, and examined patients older or equal 11 years with confirmed glioma diagnoses between 2012 and 2020. We evaluated the correlation between OS in GBM patients and sociodemographic as well as clinical factors, including age, gender, extent of tumor resection, tumor location, chemo/radiotherapy, and molecular profiling based on IDH1, MGMT, TERT, and EGFR status. Kaplan-Meier and multivariate Cox regression models were used to assess patient survival. Results: Following a comprehensive evaluation of medical records, 186 patients were enrolled in the study. The median OS was 20 months, with a 2-year survival rate of 62.5%. Among the 132 patients with available IDH measurements, 105 (79.5%) exhibited IDH1 wild-type tumors. Of the 132 patients with assessed MGMT methylation, 94 (71.2%) had MGMT methylated tumors. TERT promoter methylation was detected in 112 out of 132 cases (84.8%), while no methylation was observed in 20 cases (15.2%). Analyses using multivariable models revealed that age at histological grade (P < 0.0001), adjuvant radiotherapy (P < 0.014), IDH1 status (P < 0.026), and TERT promoter status (P < 0.030) were independently associated with OS. Conclusion: The findings of this study demonstrate that patients with higher tumor histological grades who had received adjuvant radiotherapy, exhibited IDH1 mutations, or presented with TERT promoter mutations, experienced improved OS. The median survival time was 20 months, with 15.6% and 46.9% of patients surviving at 12 and 24 months, respectively.