# Clinical and Prognostic Implications of Isocitrate Dehydrogenase Mutation in Gliomas Within a Latin American Public Oncology System: Insights From a Retrospective Panamanian Cohort

## TL;DR

This study shows that IDH mutations in gliomas are linked to better survival in Panama, highlighting the importance of molecular testing in low- and middle-income countries.

## Contribution

The study provides real-world evidence of IDH mutation's prognostic value in gliomas from a Latin American public oncology system.

## Key findings

- IDH mutation was strongly associated with improved overall survival in glioma patients.
- Age ≥ 65 years, biopsy-only procedure, and poor performance status predicted worse survival.
- Frontal-lobe tumor location was linked to better survival in multivariable analysis.

## Abstract

Introduction

Despite the recognized prognostic value of isocitrate dehydrogenase (IDH) mutations in gliomas, real-world survival data from low- and middle-income countries (LMICs), particularly in Latin America, are scarce. This study aimed to evaluate the prognostic impact of IDH mutation status on overall survival (OS) in a national cohort from Panama.

Materials and methods

We retrospectively analyzed 196 glioma patients diagnosed between 2018 and 2023 at the National Oncology Institute of Panama. Tumor histology and grade were classified according to the 2021 WHO Classification. IDH mutation status was assessed via immunohistochemistry. Patients with ependymoma or incomplete clinical records were excluded. Epidemiological variables, treatment modalities, and tumoral and molecular characteristics were collected. Kaplan-Meier survival curves, log-rank tests, and Cox regression models were applied. Analyses were performed using IBM SPSS Statistics for Windows, Version 30 (Released 2024; IBM Corp., Armonk, New York). The study protocol was approved by the Bioethics Committee of The Panama Clinic (EC-CBITPC-063).

Results

Among 196 patients, 59 (30%) were IDH-mutant and 137 (70%) were IDH-wildtype. Median OS was not reached for the IDH-mutant group but was 11.4 months (95% CI: 8.3-14.5) in the IDH-wildtype group (p < 0.001). A total of 123 patients (62.8%) died during follow-up. In multivariable analysis, age ≥ 65 years (HR 1.76; p = 0.008), biopsy-only procedure (HR 2.04; p = 0.004), and Karnofsky Index < 70% (HR 2.02; p = 0.010) predicted worse OS. IDH mutation (HR 0.25; p < 0.001) and frontal-lobe location (HR 0.61; p = 0.039) were associated with improved survival.

Conclusion

In this cohort, IDH mutation emerged as a strong independent predictor of OS. These findings support the routine implementation of IDH testing and the expansion of access to molecular diagnostics in glioma care across LMICs. Prospective studies are warranted to validate these results.