Department of Medical Oncology, AUSL / IRCCS Institute of Neurological Sciences, Bologna, Italy.
Department of Medical Oncology, AUSL / IRCCS Institute of Neurological Sciences, Bologna, Italy.
Eur J Cancer. 2020 Sep;137:10-17. doi: 10.1016/j.ejca.2020.06.018. Epub 2020 Jul 26.
Diffuse grade II and grade III gliomas are actually classified in accordance with the presence of isocitrate dehydrogenase mutation (IDH-mut) and the deletion of both 1p and 19q chromosome arms (1p/19q codel). The role of tumour grading as independent prognostic factor in these group of tumours remains matter of debate. The aim of this study was to determine if grade is an independent prognostic factor and not somehow associated to IDH mutation and 1p/19q status of the tumour.
We analysed 399 consecutive patients with newly diagnosed, histologically proven World Health Organisation (WHO) 2016 grade II or grade III IDH-mut gliomas, assessed by polymerase chain reaction, immunohistochemistry or next-generation sequencing (NGS).
The analysis included 399 patients with grade II (n = 250, 62.7%) or grade III (n = 149, 37.3%) diffuse gliomas. Median follow-up time was 105.3 months. Median survival was 148.1 months. In multivariate analysis, grade II (hazard ratio [HR] = 0.342, 95% confidence interval [CI]: 0.221-0.531; P < 0.001) and 1p/19q codeletion (HR = 0.440, 95% CI: 0.290-0.668; P < 0.001) were independently associated with a lower risk for death. The difference in survival remained significant (p = 0.006 in astrocytomas, p = 0.014 in oligodendrogliomas) when adjusted for histological subtype. Residual disease after surgery (or biopsy) negatively affected survival (HR: 2.151, 95% CI: 1.375-3.367, P = 0.001). Post-surgical treatment with radiotherapy + adjuvant chemotherapy improved survival compared with follow-up and other treatments (HR: 0.316, 95% CI: 0.156-0.641, P = 0.001).
In our study, histopathological grade still affects survival in IDH-mutant WHO grade II and III diffuse gliomas. This effect appears to be independent from molecular features, extension of surgical resection and post-surgical treatments. Therefore, physicians should continue to take into account tumour grade, along their molecular characteristics, for a better clinical and therapeutic management of the patients.
弥漫性二级和三级神经胶质瘤实际上是根据异柠檬酸脱氢酶突变（IDH-mut）的存在和 1p 和 19q 染色体臂缺失（1p/19q 编码）进行分类的。肿瘤分级作为这些肿瘤的独立预后因素的作用仍然存在争议。本研究的目的是确定分级是否是一个独立的预后因素，而不是与 IDH 突变和肿瘤的 1p/19q 状态有关。
我们分析了 399 名新诊断的、经组织学证实的 2016 年世界卫生组织（WHO）二级或三级 IDH 突变型神经胶质瘤患者，这些患者通过聚合酶链反应、免疫组织化学或下一代测序（NGS）进行评估。
该分析包括 399 名 2 级（n=250，62.7%）或 3 级（n=149，37.3%）弥漫性神经胶质瘤患者。中位随访时间为 105.3 个月。中位生存期为 148.1 个月。多变量分析显示，2 级（危险比[HR]为 0.342，95%置信区间[CI]：0.221-0.531；P<0.001）和 1p/19q 编码缺失（HR 为 0.440，95%CI：0.290-0.668；P<0.001）与较低的死亡风险相关。当调整组织学亚型时，生存差异仍然显著（星形细胞瘤为 p=0.006，少突胶质细胞瘤为 p=0.014）。手术后（或活检）的残留疾病对生存有负面影响（HR：2.151，95%CI：1.375-3.367，P=0.001）。与随访和其他治疗相比，手术后接受放疗+辅助化疗可改善生存（HR：0.316，95%CI：0.156-0.641，P=0.001）。
在我们的研究中，组织病理学分级仍然影响 IDH 突变型 WHO 二级和三级弥漫性神经胶质瘤的生存。这种影响似乎独立于分子特征、手术切除范围和术后治疗。因此，医生在对患者进行更好的临床和治疗管理时，应继续考虑肿瘤分级及其分子特征。
