Wei Ruo-Lun, Zhang Li-Wei, Li Jian-Guo, Yang Feng-Dong, Xue Ya-Ke, Wei Xin-Ting
Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2020 Dec 17;10:538133. doi: 10.3389/fonc.2020.538133. eCollection 2020.
Secondary glioblastomas (sGBM) are derived from previously lower-grade [World Health Organization (WHO) grades II or III] gliomas. Lower-grade benign-behaving gliomas may retain their former grade following recurrence, or may become malignant higher-grade glioblastomas. Prediction of tumor behavior in lower-grade gliomas is critical for individualized glioma therapy. A total of 89 patients were included between January 2000 and January 2019 in the present study to establish a nomogram via univariate and multivariate logistic regression analyses. Nomogram predictive performance was tested in the validation group. We then analyzed 36 O-6-methylguanine-DNA methyltransferase () unmethylated lower-grade gliomas from patients seen at West China Hospital of Sichuan University. Survival statistics were calculated with the Kaplan-Meier method. Two clinical factors (molecular diagnosis and WHO grade), five radiological factors (location, cortical involvement, multicentricity, uniformity, and margin enhancement), one biomarker ( codeletion), and a combination of three biomarkers (+/-/-) were associated with glioma upgrading. Nomograms positive for these prognostic factors had an AUC of 0.880 in the derivation group and 0.857 in the validation group. The calibration and score-stratified survival curves for the derivation group and validation group were good. An operational nomogram was published at https://warrenwrl.shinyapps.io/DynNomapp/. The overall survival of secondary gliomas in the MGMT-unmethylated cohort were influenced independently by the use of temozolomide during the treatment of formerly low-grade gliomas (=0.00096). Clinical and radiological factors and biomarker-based behavior-oriented nomograms may offer a feasible identification tool for the detection of sGBM precursors. This method may further assist neurosurgeons with the stratification of lower-grade glioma cases and thus the development of better, more individualized treatment plans.
继发性胶质母细胞瘤（sGBM）源自先前的低级别[世界卫生组织（WHO）二级或三级]胶质瘤。低级别行为良性的胶质瘤在复发后可能保持其先前的级别，也可能转变为恶性程度更高的胶质母细胞瘤。预测低级别胶质瘤的肿瘤行为对于个体化胶质瘤治疗至关重要。本研究纳入了2000年1月至2019年1月期间的89例患者，通过单因素和多因素逻辑回归分析建立列线图。在验证组中测试列线图的预测性能。然后，我们分析了四川大学华西医院收治的36例O-6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）未甲基化的低级别胶质瘤。采用Kaplan-Meier法计算生存统计数据。两个临床因素（分子诊断和WHO分级）、五个放射学因素（位置、皮质受累、多中心性、均匀性和边缘强化）、一个生物标志物（1p/19q共缺失）以及三种生物标志物的组合（MGMT+/IDH1 -/1p/19q -）与胶质瘤升级相关。这些预后因素呈阳性的列线图在推导组中的曲线下面积（AUC）为0.880，在验证组中为0.857。推导组和验证组的校准曲线及评分分层生存曲线良好。一个实用的列线图发布于https://warrenwrl.shinyapps.io/DynNomapp/ 。在MGMT未甲基化队列中，继发性胶质瘤的总生存期独立地受到先前低级别胶质瘤治疗期间使用替莫唑胺的影响（P = 0.00096）。临床和放射学因素以及基于生物标志物的行为导向列线图可能为检测sGBM前体提供一种可行的识别工具。该方法可能进一步帮助神经外科医生对低级别胶质瘤病例进行分层，从而制定更好、更个体化的治疗方案。
