An Updated Comparison Between World Health Organization Grade II Gemistocytic and Diffuse Astrocytoma Survival and
Adrian Rodrigues1, Michael Zhang1, Angus Toland2
1Department of Neurosurgery, Stanford School of Medicine, Stanford, California, USA.
Background:
In 2016, the World Health Organization revised its guidelines to retain only gemistocytic astrocytoma (GemA) as a distinct variant of diffuse astrocytoma (DA). In the past, grade II GemAs were linked with a worse prognosis than DA. However, it is unclear how consistently the tumor subtype has been diagnosed over time. We used more recent data to compare outcomes between grade II GemA and DA.
Methods:
Patients with grade II DA and GemA were extracted from the Surveillance, Epidemiology, and End Results database between 1973 and 2016. Kaplan-Meier curves estimated survival differences across different eras, with a focus on patients diagnosed between 2000 and 2016, and propensity score matching was used to balance baseline characteristics between DA and GemA cohorts.
Results:
Of 2467 patients with grade II astrocytoma diagnosed between 2000 and 2016, 132 (5.35%) had GemA, and 2335 (94.65%) had DA. At baseline, marked demographic and treatment differences were noted between tumor subtypes, including age at diagnosis and female sex. GemA patients did not have worse survival compared with DA patients at baseline (P = 0.349) or after propensity score matching (P = 0.497). Multivariate Cox models found that surgical extent of resection was associated with a survival benefit for DA patients, and both DA and GemA patients >65 years old had dramatically inferior survival.
Conclusions:
Our data suggest that the impact of GemA versus DA histopathology depends more on the decade of queried data rather than patient-specific demographics. Using more recent longitudinal data, we found that grade II GemA and DA tumors did not have significant differences in survival. These data may prove useful for clinicians counseling patients with grade II GemA.
Insights
Gemistocytic astrocytoma (GemA) and diffuse astrocytoma (DA) grade II tumors show similar survival rates in recent data. This finding contrasts with older data and may help clinicians counsel patients more accurately.
Area of Science:
- Neuro-oncology
- Pathology
- Epidemiology
Background:
- The World Health Organization reclassified gemistocytic astrocytoma (GemA) as a diffuse astrocytoma (DA) variant in 2016.
- Historically, grade II GemA was associated with a poorer prognosis than DA.
- Diagnostic consistency of GemA over time remains unclear.
Purpose of the Study:
- To compare survival outcomes between grade II GemA and DA using recent data.
- To investigate the influence of diagnostic era on the prognostic significance of GemA versus DA.
Main Methods:
- Analysis of grade II DA and GemA cases from the Surveillance, Epidemiology, and End Results database (1973-2016).
- Kaplan-Meier survival analysis, focusing on patients diagnosed between 2000-2016.
- Propensity score matching to balance baseline characteristics between GemA and DA cohorts.
Main Results:
- Between 2000-2016, GemA constituted 5.35% of grade II astrocytomas.
- No significant survival difference was observed between GemA and DA patients at baseline (P=0.349) or after matching (P=0.497).
- Extent of resection benefited DA survival; age >65 was linked to inferior survival for both subtypes.
Conclusions:
- The prognostic impact of GemA versus DA appears to be influenced by the diagnostic era rather than patient demographics.
- Recent data indicate no significant survival difference between grade II GemA and DA.
- Findings can aid clinicians in patient counseling regarding grade II GemA.
More Related Videos
12:25Optimization of High Grade Glioma Cell Culture from Surgical Specimens for Use in Clinically Relevant Animal Models and 3D Immunochemistry
Published on: January 7, 2014
05:45Author Spotlight: Enhanced Generation of Patient-Derived 3D Organoids for Glioblastoma and Glioma
Published on: January 19, 2024
