The Overall Survival Rate Prognosis in Diffuse Astrocytic Patients Based on Isocitrate Dehydrogenase-1 Mutation Status (IDH1 R132H): An Indonesian Multicenter Study

Abstract

Objective: The IDH1 mutation status is one of the main factors indicated the prognosis of patients with astrocytic malignancies; yet, targeted sequencing is not readily available in countries with limited resources. We aimed to analyze the association between examination IDH1 status and the overall survival rates of diffuse astrocytic tumor patients. Methods: This retrospective cohort multicenter study included 327 diffuse astrocytic tumor patients, January 2017 – December 2022. The immunohistochemistry or PCR data of IDH1 mutation and MGMT status, WHO classification, and Karnofsky performance score (KPS) were collected. Statistical analysis was then performed to analyze their association with the median of follow-up time of 18-months. Result: At 36-month follow-up, the overall survival rate of patients with WHO grade IV (29.23%) was significantly lower than patients with WHO grade III and II (72.24% and 82.46%; p < 0.0001). The diffuse astrocytic tumor patients’ survival rate was also significantly influenced by the KPS score (HR 1.64 [1.08 – 2.50]; p = 0.0208). The survival rate of patients with IDH1 wildtype was significantly lower than that of patients with IDH1 mutant (HR 2.13 [1.51 – 3.00]; p = 0.0004). The overall survival rate of patients with IDH1 wildtype and wildtype MGMT unmethylated was significantly lower than patients with IDH1 mutant MGMT methylated (p < 0.0001). Conclusion: Examination of IDH1-R132H mutant is a reliable examination to predict the survival prognosis in patients with IDH1 mutant vs IDH1 wildtype; this examination could be used as an alternative to the recommended targeted sequencing of IDH1.