放射治疗延迟 IDH 突变型脑胶质瘤患者的恶性转化并延长其生存时间。
Radiotherapy delays malignant transformation and prolongs survival in patients with IDH-mutant gliomas.
机构信息
Department of Radiation Oncology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China.
National Clinical Research Center for Neurological Diseases, Beijing 100070, China.
出版信息
Cancer Biol Med. 2022 Nov 1;19(10):1477-86. doi: 10.20892/j.issn.2095-3941.2022.0472.
OBJECTIVE
IDH-mutant lower-grade gliomas (LGGs, grade 2 or 3) eventually transform into secondary grade 4 astrocytomas (sA). Here, we sought to describe the transformation time, risk factors, and outcomes in malignant transformation of IDH-mutant LGGs.
METHODS
We screened data for 108 patients with sA in the Chinese Glioma Genome Atlas who had initial IDH-mutant LGGs and underwent reoperation during 2005-2021. We evaluated the transformation time from IDH-mutant LGGs to sA, and associated risk factors and outcomes. Malignant transformation was defined as pathological confirmation of grade 4 astrocytoma.
RESULTS
The median age of the 108 patients with IDH-mutant LGGs was 35 years (range, 19-54); the median age at transformation was 40 years (range, 25-62); and the median follow-up time for all patients was 146 months (range, 121-171). The average transformation time was 58.8 months for all patients with LGGs (range, 5.9-208.1); 63.5 and 51.9 months for grade 2 and 3 gliomas, respectively; and 58.4 and 78.1 months for IDH-mutant/1p/19q-non-codeleted astrocytomas and IDH-mutant/1p/19q-codeleted oligodendrogliomas, respectively. Univariate and multivariate analysis indicated that radiotherapy [hazard ratio (HR), 0.29; 95% confidence interval (CI), 0.137-0.595; = 0.001] and non-A blood type (HR, 0.37; 95% CI, 0.203-0.680; = 0.001) were protective factors against delayed malignant transformation. Radiotherapy was associated with improved survival after transformation (HR, 0.44; 95% CI, 0.241-0.803; = 0.008), overall survival (HR, 0.50; 95% CI, 0.265-0.972; = 0.041), and progression-free survival (HR, 0.25; 95% CI, 0.133-0.479; < 0.0001) in patients with IDH-mutant gliomas.
CONCLUSIONS
Radiotherapy is associated with delayed malignant transformation and improved survival in patients with IDH-mutant gliomas.
目的
异柠檬酸脱氢酶突变型低级别胶质瘤（LGG，2 级或 3 级）最终会转化为继发性 4 级星形细胞瘤（sA）。在此，我们旨在描述 IDH 突变型 LGG 恶性转化的转化时间、风险因素和结局。
方法
我们对中国脑胶质瘤基因组图谱中 108 例初始 IDH 突变型 LGG 患者进行了筛查，这些患者在 2005-2021 年间进行了再次手术。我们评估了从 IDH 突变型 LGG 到 sA 的转化时间以及相关的风险因素和结局。恶性转化定义为病理证实为 4 级星形细胞瘤。
结果
108 例 IDH 突变型 LGG 患者的中位年龄为 35 岁（范围：19-54 岁）；转化时的中位年龄为 40 岁（范围：25-62 岁）；所有患者的中位随访时间为 146 个月（范围：121-171 个月）。所有 LGG 患者的平均转化时间为 58.8 个月（范围：5.9-208.1 个月）；2 级和 3 级胶质瘤分别为 63.5 和 51.9 个月；IDH 突变型/1p/19q-非缺失型星形细胞瘤和 IDH 突变型/1p/19q-缺失型少突胶质细胞瘤分别为 58.4 和 78.1 个月。单因素和多因素分析表明，放疗（风险比[HR]，0.29；95%置信区间[CI]，0.137-0.595； = 0.001）和非 A 血型（HR，0.37；95%CI，0.203-0.680； = 0.001）是恶性转化延迟的保护因素。放疗与转化后生存改善相关（HR，0.44；95%CI，0.241-0.803； = 0.008）、总生存（HR，0.50；95%CI，0.265-0.972； = 0.041）和无进展生存（HR，0.25；95%CI，0.133-0.479； ＜0.0001）。
结论
放疗与 IDH 突变型胶质瘤患者的恶性转化延迟和生存改善相关。
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