Liu T T, Achrol A S, Mitchell L A, Du W A, Loya J J, Rodriguez S A, Feroze A, Westbroek E M, Yeom K W, Stuart J M, Chang S D, Harsh G R, Rubin D L
From the Stanford Center for Biomedical Informatics Research and Biomedical Informatics Training Program (T.T.L., D.L.R.) Department of Radiology (T.T.L., L.A.M., W.A.D., K.W.Y., D.L.R.).
Stanford Institute for Neuro-Innovation and Translational Neurosciences (A.S.A.) Institute for Stem Cell Biology and Regenerative Medicine (A.S.A.) Department of Neurosurgery (A.S.A., J.J.L., S.A.R., E.M.W., S.D.C., G.R.H.), Stanford University School of Medicine, Stanford, California.
AJNR Am J Neuroradiol. 2016 Apr;37(4):621-8. doi: 10.3174/ajnr.A4631. Epub 2016 Jan 7.
Tumor location has been shown to be a significant prognostic factor in patients with glioblastoma. The purpose of this study was to characterize glioblastoma lesions by identifying MR imaging voxel-based tumor location features that are associated with tumor molecular profiles, patient characteristics, and clinical outcomes.
Preoperative T1 anatomic MR images of 384 patients with glioblastomas were obtained from 2 independent cohorts (n = 253 from the Stanford University Medical Center for training and n = 131 from The Cancer Genome Atlas for validation). An automated computational image-analysis pipeline was developed to determine the anatomic locations of tumor in each patient. Voxel-based differences in tumor location between good (overall survival of >17 months) and poor (overall survival of <11 months) survival groups identified in the training cohort were used to classify patients in The Cancer Genome Atlas cohort into 2 brain-location groups, for which clinical features, messenger RNA expression, and copy number changes were compared to elucidate the biologic basis of tumors located in different brain regions.
Tumors in the right occipitotemporal periventricular white matter were significantly associated with poor survival in both training and test cohorts (both, log-rank P < .05) and had larger tumor volume compared with tumors in other locations. Tumors in the right periatrial location were associated with hypoxia pathway enrichment and PDGFRA amplification, making them potential targets for subgroup-specific therapies.
Voxel-based location in glioblastoma is associated with patient outcome and may have a potential role for guiding personalized treatment.
肿瘤位置已被证明是胶质母细胞瘤患者的一个重要预后因素。本研究的目的是通过识别基于磁共振成像（MR）体素的肿瘤位置特征来表征胶质母细胞瘤病变，这些特征与肿瘤分子谱、患者特征及临床结局相关。
从2个独立队列中获取了384例胶质母细胞瘤患者的术前T1解剖MR图像（来自斯坦福大学医学中心的253例用于训练，来自癌症基因组图谱的131例用于验证）。开发了一种自动化的计算机图像分析流程来确定每位患者肿瘤的解剖位置。在训练队列中确定的生存良好组（总生存期>17个月）和生存较差组（总生存期<11个月）之间基于体素的肿瘤位置差异，被用于将癌症基因组图谱队列中的患者分为2个脑区位置组，比较这两组的临床特征、信使核糖核酸（mRNA）表达及拷贝数变化，以阐明位于不同脑区的肿瘤的生物学基础。
在训练队列和测试队列中，右侧枕颞脑室周围白质中的肿瘤均与较差的生存率显著相关（两者的对数秩检验P<0.05），并且与其他位置的肿瘤相比体积更大。右侧心房周围位置的肿瘤与缺氧途径富集及血小板衍生生长因子受体A（PDGFRA）扩增相关，使其成为亚组特异性治疗的潜在靶点。
胶质母细胞瘤基于体素的位置与患者预后相关，可能在指导个性化治疗方面具有潜在作用。
