Ochirjav Enkhee, Enkhbat Bayarmaa, Baldandorj Tuul, Choe Gheeyoung
Department of Pathology, School of Biomedicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia.
Department of Pathology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
J Pathol Transl Med. 2019 Sep;53(5):298-307. doi: 10.4132/jptm.2019.07.15. Epub 2019 Aug 2.
The 2016 World Health Organization (WHO) classification of central nervous system (CNS) tumors has been modified to incorporate the IDH mutation and 1p/19q co-deletion in the diagnosis of diffuse gliomas. In this study, we aimed to evaluate the feasibility and prognostic significance of the revised 2016 WHO classification of CNS tumors in Mongolian patients with diffuse gliomas.
A total of 124 cases of diffuse gliomas were collected, and tissue microarray blocks were made. IDH1 mutation was tested using immunohistochemistry, and 1p/19q co-deletion status was examined using fluorescence in situ hybridization analysis.
According to the 2016 WHO classification, 124 cases of diffuse brain glioma were reclassified as follows: 10 oligodendroglioma, IDHmut and 1p/19q co-deleted; three anaplastic oligodendroglioma, IDHmut and 1p/19q co-deleted; 35 diffuse astrocytoma, IDHmut, 11 diffuse astrocytoma, IDHwt, not otherwise specified (NOS); 22 anaplastic astrocytoma, IDHmut, eight anaplastic astrocytoma, IDHwt, NOS; and 35 glioblastoma, IDHwt, NOS, respectively. The 2016 WHO classification presented better prognostic value for overall survival in patients with grade II tumors than traditional histological classification. Among patients with grade II tumors, those with oligodendroglioma IDHmut and 1p/19q co-deleted and diffuse astrocytoma IDHmut showed significantly higher survival than those with diffuse astrocytoma IDHwt, NOS (p<.01).
Mongolian diffuse gliomas could be reclassified according to the new 2016 WHO classification. Reclassification revealed substantial changes in diagnosis of both oligodendroglial and astrocytic entities. We have confirmed that the revised 2016 WHO CNS tumor classification has prognostic significance in Mongolian patients with diffuse gliomas, especially those with grade II tumors.
2016年世界卫生组织（WHO）对中枢神经系统（CNS）肿瘤的分类进行了修订，将异柠檬酸脱氢酶（IDH）突变和1p/19q共缺失纳入弥漫性胶质瘤的诊断中。在本研究中，我们旨在评估2016年WHO修订的CNS肿瘤分类在蒙古族弥漫性胶质瘤患者中的可行性及预后意义。
共收集124例弥漫性胶质瘤病例，并制作组织芯片块。采用免疫组织化学检测IDH1突变，荧光原位杂交分析检测1p/19q共缺失状态。
根据2016年WHO分类，124例弥漫性脑胶质瘤重新分类如下：10例少突胶质细胞瘤，IDH突变且1p/19q共缺失；3例间变性少突胶质细胞瘤，IDH突变且1p/19q共缺失；35例弥漫性星形细胞瘤，IDH突变，11例弥漫性星形细胞瘤，IDH野生型，未另作说明（NOS）；22例间变性星形细胞瘤，IDH突变，8例间变性星形细胞瘤，IDH野生型，NOS；35例胶质母细胞瘤，IDH野生型，NOS。2016年WHO分类对Ⅱ级肿瘤患者的总生存期显示出比传统组织学分类更好的预后价值。在Ⅱ级肿瘤患者中，IDH突变且1p/19q共缺失的少突胶质细胞瘤和IDH突变的弥漫性星形细胞瘤患者的生存期显著高于IDH野生型、NOS的弥漫性星形细胞瘤患者（p<0.01）。
蒙古族弥漫性胶质瘤可根据2016年WHO新分类进行重新分类。重新分类显示少突胶质细胞和星形细胞实体的诊断有实质性变化。我们已证实，2016年WHO修订的CNS肿瘤分类对蒙古族弥漫性胶质瘤患者，尤其是Ⅱ级肿瘤患者有预后意义。
