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CC BY-NC-ND 4.0 · Asian J Neurosurg 2022; 17(01): 003-010
DOI: 10.1055/s-0042-1748789
Original Article

Risk Factors Associated with Malignant Transformation of Astrocytoma: Competing Risk Regression Analysis

Thara Tunthanathip
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Surasak Sangkhathat
2   Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
3   Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
,
Kanet Kanjanapradit
4   Department of Pathology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
› Author Affiliations
Funding The study was supported by the Health Systems Research Institute (Thailand; grant no. 63-078).
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Abstract

Background Malignant transformation (MT) of low-grade astrocytoma (LGA) triggers a poor prognosis in benign tumors. Currently, factors associated with MT of LGA have been inconclusive. The present study aims to explore the risk factors predicting LGA progressively differentiated to malignant astrocytoma.

Methods The study design was a retrospective cohort study of medical record reviews of patients with LGA. Using the Fire and Gray method, the competing risk regression analysis was performed to identify factors associated with MT, using both univariate and multivariable analyses. Hence, the survival curves of the cumulative incidence of MT of each covariate were constructed following the final model.

Results Ninety patients with LGA were included in the analysis, and MT was observed in 14.4% of cases in the present study. For MT, 53.8% of patients with MT transformed to glioblastoma, while 46.2% differentiated to anaplastic astrocytoma. Factors associated with MT included supratentorial tumor (subdistribution hazard ratio [SHR] 4.54, 95% confidence interval [CI] 1.08–19.10), midline shift > 1 cm (SHR 8.25, 95% CI 2.18–31.21), and nontotal resection as follows: subtotal resection (SHR 5.35, 95% CI 1.07–26.82), partial resection (SHR 10.90, 95% CI 3.13–37.90), and biopsy (SHR 11.10, 95% CI 2.88–42.52).

Conclusion MT in patients with LGA significantly changed the natural history of the disease to an unfavorable prognosis. Analysis of patients' clinical characteristics from the present study identified supratentorial LGA, a midline shift more than 1 cm, and extent of resection as risk factors associated with MT. The more extent of resection would significantly help to decrease tumor burden and MT. In addition, future molecular research efforts are warranted to explain the pathogenesis of MT.

Keywords

malignant transformation - low-grade glioma - high-grade glioma - diffuse astrocytoma

Authors' Contributions

T.T.: Concept, study design, data collection, statistical analysis, literature overview, and discussion. S.S.: Concept, study design, data collection, literature overview, and discussion. K.K.: Concept, data collection, and discussion.




Publication History

Article published online:
01 June 2022

© 2022. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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