Molecular Reclassification of Diffuse Gliomas: A Feasibility Study of Clinical Features and Survival Outcomes in Colombia

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Background/Objectives: The reclassification of gliomas in the 5th edition of the World Health Organization’s Classification of Tumors of the Central Nervous System (WHOCNS5) integrates histological and molecular criteria to improve diagnostic accuracy and enable an individualized treatment approach. This study aims to analyze the feasibility of WHOCNS5 reclassification by examining its impact on diagnostic distribution, clinical features, and overall survival (OS) in adult patients from Colombia. Methods: We retrospectively analyzed 68 adults with diffuse gliomas (2015–2023) from two referral hospitals in Bogotá, Colombia. Molecular testing for IDH, 1p/19q, ATRX, TP53, EGFR, TERT, and CDKN2A/B enabled tumor reclassification according to WHOCNS5. Clinical, radiographic, and survival data were statistically analyzed. Results: 58.8% of patients were male, with a mean age of 56.6 ± 15.5 years. A total of 51.5% of the cases varied in the diagnosis after molecular reclassification. WHOCNS5 identified 66.2% glioblastomas vs 48.5% according to WHOCNS3, and 11.8% oligodendrogliomas vs 17.6 according to WHOCNS3. Using the WHOCNS3 criteria, OS differed significantly among tumor subtypes (p = 0.03), while reclassification under WHOCNS5 reduced these differences (p = 0.13), although IDH-mutant astrocytomas and oligodendrogliomas showed a survival advantage. In all subtypes, a younger age and gender predicted better OS (p < 0.001 and p = 0.02, respectively). Conclusions: Implementing the WHOCNS5 reclassification substantially altered glioma categorization and refined prognostic interpretation in over half of the cases. Trends toward improved outcomes in IDH-mutant tumors persist after reclassification.

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