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The characteristics of  IDH -wild-type lower-grade astrocytoma remain unclear. According to cIMPACT-NOW update 3,  IDH -wild-type astrocytomas with any of the following factors show poor prognosis: combination of chromosome 7 gain and 10 loss (+ 7/− 10), and/or  EGFR  amplification, and/or  TERT  promoter ( TERT p) mutation. Multiplex ligation-dependent probe amplification (MLPA) can detect copy number alterations at reasonable cost. The purpose of this study was to identify a precise, cost-effective method for stratifying the prognosis of  IDH -wild-type astrocytoma. Sanger sequencing, MLPA, and quantitative methylation-specific PCR were performed for 42  IDH -wild-type lower-grade astrocytomas surgically treated at Kyoto University Hospital, and overall survival was analysed for 40 patients who underwent first surgery. Of the 42  IDH -wild-type astrocytomas, 21 were classified as grade 4 using cIMPACT-NOW update 3 criteria and all had either  TERT p mutation or  EGFR  amplification. Kaplan–Meier analysis confirmed the prognostic significance of cIMPACT-NOW criteria, and World Health Organization grade was also prognostic. Cox regression hazard model identified independent significant prognostic indicators of  PTEN  loss (risk ratio, 9.75;  p  < 0.001) and  PDGFRA  amplification (risk ratio, 13.9;  p  = 0.002). The classification recommended by cIMPACT-NOW update 3 could be completed using Sanger sequencing and MLPA. Survival analysis revealed  PTEN  and  PDGFRA  were significant prognostic factors for  IDH -wild-type lower-grade astrocytoma.

Prognostic stratification for IDH-wild-type lower-grade astrocytoma by Sanger sequencing and copy-number alteration analysis with MLPA