Clinical Utility and Prognostic Value of IDH Mutation in Gliomas Patients in Kurdistan Region: A Retrospective Comparative Analysis With Wild-Type Variants

Abstract

Background:
Isocitrate dehydrogenase (IDH) mutation has emerged as a key molecular biomarker in gliomas, with significant implications for diagnosis, classification, and prognosis under the WHO CNS5 framework. However, regional data from the Kurdistan Region of Iraq remain limited, particularly regarding its real-world clinical utility.

Objective:
To evaluate the clinical and prognostic significance of IDH mutation status among glioma patients in the Kurdistan Region through a retrospective comparative analysis.

Methods:
This retrospective, multicenter observational study included 150 histopathologically confirmed glioma patients treated between October 2023 and January 2026 across major oncology centers in Erbil, Duhok, and Sulaymaniyah. Patients were stratified into IDH-mutant and IDH wild-type groups. Clinicodemographic, histopathological, treatment, and survival data were analyzed. Survival outcomes were assessed using Kaplan–Meier analysis and Cox proportional hazards models.

Results:
IDH mutation was identified in 24.0% of patients. IDH-mutant patients were significantly younger at diagnosis compared to wild-type patients (43.1 ± 14.2 vs. 49.8 ± 12.8 years, p < 0.05). IDH-mutant tumors were associated with lower WHO grades and higher prevalence of astrocytoma and oligodendroglioma subtypes (p < 0.001). Disease progression was significantly lower in the IDH-mutant group (44.4% vs. 70.2%, p = 0.002), with longer time to progression (28.3 vs. 12.6 months, p < 0.001). Overall survival was significantly improved in IDH-mutant patients (34.2 vs. 18.4 months; HR = 0.42, 95% CI: 0.28–0.64, p < 0.001). Multivariable analysis confirmed IDH mutation as an independent predictor of improved survival (HR = 0.45, p < 0.001).

Conclusion:
IDH mutation status is a strong independent prognostic marker in glioma patients in the Kurdistan Region, associated with significantly improved survival outcomes. These findings support routine implementation of molecular diagnostics and highlight the importance of integrating IDH status into clinical decision-making and regional neuro-oncology practice.