RTHP-16. PATTERNS OF TREATMENT AND OUTCOMES OF 1p19q CO-DELETED GLIOMAS

摘要

Molecular markers are redefining classification of lower grade gliomas and ushering in a paradigm shift in their management. Our objective was to evaluate histologic grade on patterns of care and treatment outcomes for 1p19q co-deleted gliomas. We evaluated 737 patients in the National Cancer Database diagnosed with 1p19q co-deleted gliomas from 2004 through 2012 and treated with surgery followed by radiation therapy (RT), chemotherapy (CT), or combined-modality therapy. Patients with grade II tumors were more likely to receive surgery only than those with grade III tumors (58.1% vs. 14.8%, p<0.001), whereas those with grade III tumors were more likely to receive combined-modality therapy (52.2% vs. 6.1%, p<0.001). Among 472 patients with available follow-up, grade predicted overall survival, with an 8% difference at 2 years (98.2% grade II vs. 90.6% grade III, p<0.001). In a Cox multivariable proportional hazards model adjusting for patient and treatment factors, age (>59 yrs vs. <40 yrs; hazard ratio [HR] 15.66, 95% confidence interval [CI] 3.68–66.61, p<0.001), grade (III vs. II; HR 5.84, 95% CI 1.91–17.81, p=0.001), and histology (oligodendroglioma vs. other; HR 0.23, 95% CI 0.10–0.53, p=0.001) were associated with survival. Outcomes after surgery alone were different for grade II and grade III tumors (99.3% grade II vs. 75.7% grade III survival at 2 years, p<0.001), but the addition of post-operative therapy closed the gap between grades. Longer follow-up and additional molecular characterization is needed to further determine the influence of tumor grade in the management of type I 1p19q co-deleted glioma.