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Malignant transformation in low-grade astrocytoma for long-term monitoring

Thara Tunthanathip
Published: 1 January 2022
 by  Medknow

Abstract: Background: Malignant transformation (MT) of low-grade astrocytoma (LGA) produces a poor prognosis in benign tumors. Currently, variables linked with MT of LGA have proven equivocal. The present study aims to evaluate the risk variables, indicating that LGA gradually differentiates to malignant astrocytoma. Methods: Retrospective cohort analysis of LGA patients was performed. Both univariate and multivariate studies were used to discover variables connected to MT using the Cox regression method. As a result, the cumulative incidence of MT for each covariate survival curve was built after the final model. Results: In the current study, 115 individuals with LGA were included in the analysis, and MT was found in 16.5% of cases. In the case of MT, 68.4% of patients progressed to glioblastoma, whereas 31.6% progressed to anaplastic astrocytoma. Significant factors included supratentorial tumor (hazard ratio (HR) 3.41, 95% CI 1.18–12.10), midline shift > 5 mm (HR 7.15, 95% CI 2.28–34.33), and non-total resection as follows: subtotal resection (HR 5.09, 95% CI 0.07–24.02), partial resection (HR 1.61, 95% CI 1.09–24.11), and biopsy (HR 2.80, 95% CI 1.18–32.52). Conclusion: In individuals with LGA, MT dramatically altered the disease's natural history to a poor prognosis. The present study's analysis of the clinical features of patients indicated supratentorial LGA, a midline shift greater than 5 mm, and the degree of resection as risk factors for MT. The more extensive the resection, the greater the reduction in tumor load and MT. In addition, more molecular study is necessary to elucidate the pathophysiology of MT.
Keywords: Diffuse astrocytoma / high-grade glioma / low-grade glioma / malignant transformation / pilocytic astrocytoma

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