Introduction

Astrocytomas are the most common primary tumors in the central nervous system (CNS). These tumors arise from astrocytes—star-shaped cells that make up the “glue-like” or supportive tissue of the brain. The diagnosis is based primarily on histopathological criteria defined by the World Health Organisation (WHO) that grades astrocytomas as pilocytic astrocytoma (grade I), diffuse astrocytoma (grade II), anaplastic astrocytoma (grade III), and glioblastoma (grade IV).

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Diffuse astrocytomas (DA) are grade II astrocytomas also known as low-grade astrocytomas.  DA consists of fibrillary astrocytoma, protoplasmic astrocytoma, and gemistocytic astrocytoma. Diffuse astrocytoma is a slow-growing brain tumor. They are infiltrating tumors with ill-defined borders. Although diffuse astrocytoma is a relatively slow-growing tumor with a median survival time of 5-8 years, they have a high recurrence rate due to diffuse infiltration of brain tissue and an inherent malignant potential to transform into high-grade astrocytomas. Clinical symptoms of DA vary depending on the location of the tumor. Seizures, headaches, and focal neurologic deficits are the most frequent presenting symptoms.  The histopathological diagnosis of a diffuse astrocytoma can be challenging due to its pronounced heterogeneity. Hence, the tumor characteristics and the factors associated with the prognosis are inadequately understood. However, studies about the clinicopathological characteristics of DA are scarce in the literature at present. Factors influencing the prognosis of DA are also unclear. Thus, identifying the factors associated with prognosis and survival rate in DA patients is necessary.