Citations 1
PATH-82. Multivariate survival risk stratification in GBMs lacking necrosis and microvascular proliferation
Molinaro, Annette M, McCoy, Lucie , Warrier, Gayathri , Al-Adli, Nadeem , Mendez, Joe , Malani, Rachna , Hamel, Elaine, Odell, Jennifer Ledbetter, Reardon, David A. , Decker, Paul, Eckel‐Passow, Jeanette E. , Kosel, Matthew , Kollmeyer, Thomas M. , Kizilbash, Sani H. , Jenkins, Robert B. , Wen, Patrick Y. , Solomon, David, Chang, Susan M. , Colman, Howard , Kollmeyer, Thomas , Kizilbash, Sani H , Warrier, Gayathri , Young, Jacob S. , Hamel, Elaine, Odell, Jennifer Ledbetter, Eldred, Blaine S.C. , Nghiemphu, Phioanh L. , Liau, Linda M. , Ligon, Keith L , Lachance, Daniel Honore , Burns, Terry C. , Ida, Cristiane M. , Vaubel, Rachael A. , Giannini, Caterina , Maqbool, Muhammad Asad , Shafqat, Shameel , Mansouri, Alireza , Cloughesy, Timothy F. , Lai, Albert, Youssef, Gilbert , Wen, Patrick Yung , Groot, John de , Colman, Howard
Neuro-Oncology | November 11, 2025 | Volume: 27 | Issue: Supplement_5 | Pages: v260-v261
Abstract IDH-wildtype diffuse astrocytic gliomas with lower-grade histological features alongside specific genomic alterations (e.g., TERT promoter mutation, EGFR amplification, gain Chr7/loss Chr10) are presently diagnosed as glioblastoma, IDH-wildtype (GBM) under WHO 2021 criteria. Previous analyses categorized these into “early/evolving” or “surgically undersampled” GBMs. However, it remains unclear whether these tumors share identical clinical and prognostic features with histologic GBM. Data from IDH-wt molecular GBMs across six institutions were aggregated. Astrocytic IDH-wt tumors of any grade that lacked necrosis or microvascular proliferation on initial histopathology yet exhibited molecular alterations consistent with WHO 2021 GBM diagnosis, were included. Recursive partitioning analysis (RPA) was used to categorize patients into risk groups based on overall survival (OS). Among the 264 patients included, the median age was 60 years (IQR: 51-67), with 162 (61%) being male. Additionally, 210 (80%) were diagnosed since 2016, and 216 (82%) received chemoradiation plus adjuvant temozolomide (GBM-SOC). The median follow-up period was 3.9 years (95% CI: 3.4, 4.6). Identified univariate risk factors for worse survival included older age, biopsy-only status, EGFR amplification, absence of initial adjuvant treatment, low post-operative KPS, and tumor histologic grade of 3. RPA divided patients into four distinct survival groups (p<0.0001). The “best” risk group comprised lower grade (<=2) tumors (n=58, median OS (mOS): 40 months (95% CI: 33, NA)). The “second best” group included Grade 3 patients receiving GBM-SOC without steroids during initial RT (n=139, mOS: 25 months (95% CI: 22, 28)). The “second worst” group encompassed Grade 3 patients who were on steroids during initial RT while receiving GBM-SOC (n=38, mOS: 15 months (95% CI: 13, 20)). The “worst” group contained Grade 3 tumors that had not undergone SOC (n=29, mOS: 9 months (95% CI: 4, 26)). These data show that histologic features and treatment are strong indicators of patient outcomes.