Abstract
Astrocytoma can be found to develop malignancy in 9-23 percent that is significantly associated with poor prognosis. From a literature review, lack of evidence mentioned about risk factors associated with malignant transformation. The study objectives were 1. to identify factors associated with malignant transformation 2. To identify the prognosis of astrocytoma that developed malignant transformation according to biomarkers. Method The present study was a retrospective cohort study and the study population was patients who were diagnosed with low-grade astrocytoma. The processes of the study comprised 4 processes as follows: 1. investigation of the candidate genes from fresh frozen tissue 2. Investigation of candidate gene mutations 3. survival analysis 4. nomogram development. Results Following whole-genome sequencing, IDH 1 and IDH 2 mutations were candidate genes. In 90 patients, IDH 1 and IDH 2 mutations were found in 12.2% and 10%, respectively. Malignant transformation was associated with a short survival time (log-rank test, p=0.006). Factors associated with malignant transformation were a supratentorial tumor, midline shift of more than 1 cm, the extent of resection, and IDH 1 mutations following multivariable analysis. Therefore, a nomogram was developed for predicting malignant transformation. Conclusion Malignant transformation was significantly associated with poor prognosis; therefore, a close follow-up strategy should be applied in high-risk patients.
