Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
Division of Neuropathology, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom.
World Neurosurg. 2021 Jul;151:e217-e233. doi: 10.1016/j.wneu.2021.04.026. Epub 2021 Apr 15.
World Health Organization (WHO) grade II and III isocitrate dehydrogenase wild-type (IDH-wt) gliomas are often treated as WHO grade IV glioblastomas. However, cumulative evidence indicates that IDH mutation status alone is insufficient in predicting survival. The current study examines molecular and clinical markers to further prognostically stratify WHO grade II and III gliomas, in particular, IDH-wt.
A single institution's records were retrospectively reviewed for molecularly stratified WHO grade II and grade III gliomas over a 9-year period (2010-2019). Clinical data, IDH1/IDH2 status, EGFR amplification, and other molecular markers were recorded and correlated to the study outcomes. These outcomes were defined as progression-free survival (PFS), overall survival (OS), and time to malignant progression (TtMP).
A total of 167 and 42 WHO grade II and III gliomas, respectively, were identified, totaling 209 cases with 157 IDH1/2 mutated and 52 IDH-wt tumors. The presence of IDH1/2 mutation was associated with longer OS (P < 0.0001) and PFS (P < 0.0001) but not with TtMP (P = 0.314). Lack of EGFR amplification, younger age, and greater extent of resection (EOR) (≥80%) were identified as independent, favorable OS prognostic factors. In the IDH-wt cohort, multivariate analysis indicated that older age (P = 0.003) and lesser EOR (<80%) (P = 0.007) are associated with worse OS. In addition, EGFR amplification showed a trend toward shorter OS in the IDH-wt cohort (P = 0.073).
IDH1/2 mutation favors longer OS and PFS but does not protect from malignant progression. Lack of EGFR amplification, younger age and greater EOR are favorable OS prognosticators. In the IDH-wt cohort, older age and lesser EOR were linked to worse OS.
世界卫生组织（WHO）二级和三级异柠檬酸脱氢酶野生型（IDH-wt）胶质瘤通常被视为 WHO 四级胶质母细胞瘤。然而，越来越多的证据表明，IDH 突变状态本身不足以预测生存。本研究通过检查分子和临床标志物，进一步对 WHO 二级和三级胶质瘤，特别是 IDH-wt 进行预后分层。
对一家机构 9 年来（2010-2019 年）进行分子分层的 WHO 二级和三级胶质瘤的记录进行了回顾性分析。记录了临床数据、IDH1/IDH2 状态、EGFR 扩增和其他分子标志物，并将其与研究结果相关联。这些结果定义为无进展生存期（PFS）、总生存期（OS）和恶性进展时间（TtMP）。
共确定了 167 例 WHO 二级和 42 例 WHO 三级胶质瘤，共计 209 例，其中 157 例 IDH1/2 突变，52 例 IDH-wt 肿瘤。IDH1/2 突变的存在与较长的 OS（P<0.0001）和 PFS（P<0.0001）相关，但与 TtMP 无关（P=0.314）。无 EGFR 扩增、年龄较小和更大程度的切除（EOR）（≥80%）被确定为独立的有利 OS 预后因素。在 IDH-wt 队列中，多变量分析表明，年龄较大（P=0.003）和 EOR 较小（<80%）（P=0.007）与较差的 OS 相关。此外，EGFR 扩增在 IDH-wt 队列中也表现出 OS 较短的趋势（P=0.073）。
IDH1/2 突变有利于较长的 OS 和 PFS，但不能防止恶性进展。无 EGFR 扩增、年龄较小和更大的 EOR 是有利的 OS 预后因素。在 IDH-wt 队列中，年龄较大和 EOR 较小与较差的 OS 相关。
