Dahlrot Rikke H, Kristensen Bjarne W, Hjelmborg Jacob, Herrstedt Jørn, Hansen Steinbjørn
Department of Oncology, Odense University Hospital Odense, Denmark.
Int J Clin Exp Pathol. 2013;6(1):31-40. Epub 2012 Nov 20.
High-grade gliomas have a dismal prognosis, and prognostic factors are needed to optimize treatment algorithms. In this study we identified clinical prognostic factors as well as the prognostic value of isocitrate dehydrogenase 1 (IDH1) status in a population-based group of patients with high-grade gliomas. Using the Danish Cancer Registry and the Danish Pathology Databank we identified 359 patients: 234 had WHO grade IV gliomas, 58 had WHO grade III gliomas, and 67 were diagnosed clinically. Mutated IDH1 was predominantly observed in oligodendroglial tumors (WHO grade III). Patients with mutated IDH1 had a significantly better outcome than patients with wildtype IDH1: 2-year OS 59% and 18%, respectively (HR 0.38, 95% CI 0.21-0.68). However, when adjusting for other prognostic factors, IDH1 status was not a significant independent prognostic factor (HR=0.58, 95% CI 0.32-1.07). Young age, absence of neurological deficit, performance status 0-1, tumor not crossing the midline, and receiving post-surgical treatment were significant independent indicators of a good prognosis in multivariate analysis.
This population-based study could not demonstrate IDH1 status to be an independent prognostic factor in high-grade gliomas when adjusting for the effect of classic prognostic factors.
高级别胶质瘤预后不佳，需要预后因素来优化治疗方案。在本研究中，我们在一组基于人群的高级别胶质瘤患者中确定了临床预后因素以及异柠檬酸脱氢酶1（IDH1）状态的预后价值。利用丹麦癌症登记处和丹麦病理数据库，我们确定了359例患者：234例为世界卫生组织（WHO）IV级胶质瘤，58例为WHO III级胶质瘤，67例为临床诊断病例。IDH1突变主要见于少突胶质细胞瘤（WHO III级）。IDH1突变患者的预后明显优于野生型IDH1患者：2年总生存率分别为59%和18%（风险比[HR]=0.38，95%置信区间[CI]=0.21 - 0.68）。然而，在调整其他预后因素后，IDH1状态并非显著的独立预后因素（HR = 0.58，95% CI = 0.32 - 1.07）。在多变量分析中，年轻、无神经功能缺损、体能状态0 - 1、肿瘤未跨越中线以及接受术后治疗是良好预后的显著独立指标。
在调整经典预后因素的影响后，这项基于人群的研究未能证明IDH1状态是高级别胶质瘤的独立预后因素。
