Prognostic and Predictive Effect of Age in Molecularly Defined Lower-Grade Gliomas.
prospective_cohort · Level II
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- Record sourced from PubMed, PMID 42585601.
- Also identified by DOI 10.1200/JCO-25-01846.
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Abstract
Age ≥40 years is regarded as a high-risk feature and an indication for adjuvant chemoradiotherapy for patients with lower-grade glioma in clinical practice guidelines. It is unclear whether age remains a relevant prognostic factor for contemporary definitions of lower-grade gliomas in the molecular era. The Prospective Gliomas Research (PROGRES) database contains individual patient-level data from 11 prospective clinical trials or observational registries of histologically defined lower-grade 2-3 oligodendroglioma or astrocytoma. We determined the association of age (18-39 years <i>v</i> ≥40 years) with progression-free survival (PFS) stratified by isocitrate dehydrogenase 1 or 2 (<i>IDH1/2</i>) status, using log-rank tests and Cox regression models. We validated our findings in a separate multi-institutional retrospective cohort (Retrospective Glioma Research [REGRES] database). We identified 1,619 and 1,292 eligible patients in the PROGRES and REGRES cohorts, respectively. <i>IDH</i>-wildtype tumors were more common in patients 40 years and older (38% <i>v</i> 5%, odds ratio: 11.3 [95% CI, 6.5 to 19.7]). Age was associated with PFS in <i>IDH</i>-wildtype (5-year PFS for ≥40 <i>v</i> 18-39 years: 6% <i>v</i> 24%, hazard ratio [HR], 1.74 [95% CI, 1.21 to 2.50]) but not in <i>IDH</i>-mutant glioma (60% <i>v</i> 59%, HR, 0.89 [95% CI, 0.76 to 1.05], <i>P</i><sub>interaction</sub> < .001). In <i>IDH</i>-wildtype tumors, older age predicted aggressive molecular features, including <i>TERT</i> promoter mutation (65% <i>v</i> 28%), <i>EGFR</i> amplification (41% <i>v</i> 15%), and chromosome +7/-10 alteration (57% <i>v</i> 25%). In a pooled analysis of four clinical trials, age was not predictive of a benefit from chemoradiotherapy versus radiotherapy alone for <i>IDH</i>-mutant glioma. In the absence of additional clinical or molecular risk factors, age alone should not be considered an indication for administration or deferral of adjuvant treatment. Practice guidelines should be revised to reflect contemporary prognostic factors in the molecular era.