Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study

Ahmet Ünlü; Asım Armağan Aydın

doi:10.47582/jompac.1864399

Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study

Abstract

Aims: Astrocytoma, IDH-mutant, CNS WHO grade 4 represents a biologically distinct subgroup of high-grade gliomas characterized by more favorable outcomes than IDH-wild-type glioblastoma. However, despite the uniform application of glioblastoma-based treatment paradigms, substantial heterogeneity in survival persists, and the clinical, molecular, and treatment-related determinants of outcomes in this entity remain incompletely defined. Methods: We conducted a retrospective single-center cohort study of adult patients with histologically and molecularly confirmed IDH-mutant grade 4 astrocytomas treated between 2013 and 2024. Clinical, surgical, molecular, and treatment related variables were analyzed for associations with OS and PFS. Survival outcomes were estimated using the Kaplan–Meier method, and prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models. To avoid immortal time bias, adjuvant temozolomide duration was not included in the primary multivariable analyses. Results: A total of 46 patients were included, with a median follow-up of 19.7 months. The median OS and PFS were 26.0 months (95% CI, 21.4–30.6) and 17.7 months (95% CI, 15.8–19.6), respectively. In multivariable analyses, ECOG performance status, Ki-67 proliferation index, and MGMT promoter methylation status emerged as independent predictors of OS, whereas performance status, extent of surgical resection, and MGMT promoter methylation independently predicted PFS. Completion of 12 cycles of adjuvant temozolomide was associated with improved survival in univariate analyses but was interpreted cautiously due to its time-dependent nature. Conclusion: Survival heterogeneity in IDH-mutant grade 4 astrocytomas reflects the combined influence of tumor biology and host-related factors, rather than the molecular subtype alone. Integrating functional performance, proliferative activity, and MGMT promoter status may enhance risk stratification and inform individualized clinical decision-making for this distinct glioma subtype.

Keywords

Supporting Institution

No funding or institutional support was received for this study.

Project Number

None

Ethical Statement

This study was performed in accordance with the principles of the Declaration of Helsinki and received approval from the Institutional Review Board of the University of Health Sciences Antalya Training and Research Hospital and the Antalya Provincial Health Directorate (Approval No. 2025-485; December 11, 2025). The requirement for written informed consent was waived due to the retrospective nature of the study and the use of anonymized patient data.

Thanks

The authors declare no acknowledgments.

References

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Details

Primary Language

English

Subjects

Clinical Oncology

Journal Section

Research Article

Authors

Ahmet Ünlü ^*
0000-0001-6654-3815
Türkiye

Asım Armağan Aydın
0000-0001-8749-9825
Türkiye

Publication Date

March 27, 2026

Submission Date

January 15, 2026

Acceptance Date

March 12, 2026

Published in Issue

Year 2026 Volume: 7 Number: 2

DOI

https://doi.org/10.47582/jompac.1864399

IZ

https://izlik.org/JA95HU69PD

Cite

RIS / Bibtex

APA

Ünlü, A., & Aydın, A. A. (2026). Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study. Journal of Medicine and Palliative Care, 7(2), 336-343. https://doi.org/10.47582/jompac.1864399

AMA

1.Ünlü A, Aydın AA. Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study. J Med Palliat Care / JOMPAC / jompac. 2026;7(2):336-343. doi:10.47582/jompac.1864399

Chicago

Ünlü, Ahmet, and Asım Armağan Aydın. 2026. “Clinical, Molecular, and Treatment-Related Predictors of Survival in IDH-Mutant Grade 4 Astrocytoma: A Single-Center Cohort Study”. Journal of Medicine and Palliative Care 7 (2): 336-43. https://doi.org/10.47582/jompac.1864399.

EndNote

Ünlü A, Aydın AA (March 1, 2026) Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study. Journal of Medicine and Palliative Care 7 2 336–343.

IEEE

[1]A. Ünlü and A. A. Aydın, “Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study”, J Med Palliat Care / JOMPAC / jompac, vol. 7, no. 2, pp. 336–343, Mar. 2026, doi: 10.47582/jompac.1864399.

ISNAD

Ünlü, Ahmet - Aydın, Asım Armağan. “Clinical, Molecular, and Treatment-Related Predictors of Survival in IDH-Mutant Grade 4 Astrocytoma: A Single-Center Cohort Study”. Journal of Medicine and Palliative Care 7/2 (March 1, 2026): 336-343. https://doi.org/10.47582/jompac.1864399.

JAMA

1.Ünlü A, Aydın AA. Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study. J Med Palliat Care / JOMPAC / jompac. 2026;7:336–343.

MLA

Ünlü, Ahmet, and Asım Armağan Aydın. “Clinical, Molecular, and Treatment-Related Predictors of Survival in IDH-Mutant Grade 4 Astrocytoma: A Single-Center Cohort Study”. Journal of Medicine and Palliative Care, vol. 7, no. 2, Mar. 2026, pp. 336-43, doi:10.47582/jompac.1864399.

Vancouver

1.Ahmet Ünlü, Asım Armağan Aydın. Clinical, molecular, and treatment-related predictors of survival in IDH-mutant grade 4 astrocytoma: a single-center cohort study. J Med Palliat Care / JOMPAC / jompac. 2026 Mar. 1;7(2):336-43. doi:10.47582/jompac.1864399