Survival Differences by IDH Mutation Status Among Diffuse Astrocytoma Patients: a SEER Analysis, 2018-2020 Open Access
Chen, James (Summer 2024)
Abstract
Abstract
Survival Differences by IDH Mutation Status Among Diffuse Astrocytoma Patients: a SEER Analysis, 2018-2020
By James Chen
Background: The isocitrate dehydrogenase gene encodes an enzyme that catalyzes reactions as part of the citric acid cycle. This gene is frequently mutated in gliomas, including diffuse astrocytoma. In recent years, IDH mutation has become the subject of increasing interest as studies have found that IDH mutation predicts better survival in glioma patients, as well as better response to radiation therapy and chemotherapy. This growing body of evidence lead the WHO to alter its classification of gliomas to include IDH mutation status in 2016. Due to the relative recency of these developments, there is a dearth of IDH mutation data in population level databases, and consequently most of the evidence for the association between IDH mutation and survival in glioma patients is limited to clinical data. Older studies also do not clearly differentiate between cancer subtypes according to the WHO’s new classification system. This study seeks to address this gap and confirm that the association observed in clinical data can also be observed in SEER’s population level data in a clearly defined sample of diffuse astrocytoma patients.
Methods: 246 IDH-mutant and 148 IDH-WT patients were identified using 2000-2020 brain biomarker data from the SEER database. Kaplan-Meier survival curves were generated to compare survival between IDH mutant and WT patients, and a stratified Cox model was run to calculate the hazard ratio associated with IDH mutation status, controlling for age, race, sex, radiation, chemotherapy, surgery, stage, primary site and 1p/19q co-deletion.
Results: Kaplan-Meier curves found that IDH mutant patients demonstrated enhanced survival over IDH wildtype patients (p<0.0001). Multivariable analysis using a stratified Cox model showed a statistically significant difference in survival comparing IDH wildtype to IDH mutant patients (HR: 6.73, 95% CI: 3.03 – 14.92, p < 0.0001).
Conclusion: IDH mutation predicts enhanced survival among diffuse astrocytoma patients. Further research is needed to explore the potential of IDH mutation status as a treatment guideline on diffuse astrocytoma patients via examining effect measure modification by chemotherapy. As IDH mutation is a relatively recent addition to national cancer databases such as SEER, time is needed to accumulate data for a more comprehensive and statistically powered analysis.
Table of Contents
TABLE OF CONTENTS
Introduction……………………………………………………………………………………………..…1
Background……………………………………………………………………………….........………...1
Diffuse Astrocytoma………………………………………………………………………..…….2
IDH Mutation………………………………………………………………………….……………2
Methods……………………………………………………….…………….……………………………...4
Results………………………………………………………………………………………….……………6
Discussion……………………………………………………………….………………………………….8
Limitations…………………………………………………………………………………………8
References…………………………………………………………………………………………………10
Figure 1.…….……….……….……….……….…………………………….…….…….…….…….…..13
Table 1……………………….…………………………………………………….………………………14
Table 2……………………….…………………………………………………….………………………15
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