Liu Vicki, Wetzel Ethan A, Eldred Blaine S C, Zapanta Rinonos Serendipity, Prins Terry J, Khanlou Negar, Liau Linda M, Chong Robert, Nghiemphu Phioanh L, Cloughesy Timothy F, Ellingson Benjamin M, Lai Albert
Department of Neurology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California, USA.
Neurooncol Adv. 2023 Apr 11;5(1):vdad036. doi: 10.1093/noajnl/vdad036. eCollection 2023 Jan-Dec.
Lower-grade mutant glioma patients frequently undergo malignant transformation (MT), with apparent worse prognosis. Many studies examine MT in mixed status cohorts and define MT using imaging, not histopathology. Our study examines the timing, predictors, and prognostic implications of pathologically determined MT in a large, exclusively mutant cohort.
We identified 193 mutant lower-grade glioma patients at UCLA who received multiple surgeries. We examined the outcomes of pathologically determined MT patients.
Time to MT is longer in grade 2 oligodendroglioma (G2 Oligo) than in grade 2 astrocytoma (G2 Astro) (HR = 0.46, = .0007). The grade 3 astrocytoma (G3 Astro) to grade 4 astrocytoma (G4 Astro) interval is shorter in stepwise MT (G2 to G3 to G4 Astro) patients than in initial G3 Astro patients ( = .03). Novel contrast enhancement had 65% positive predictivity, 67% negative predictivity, 75% sensitivity, and 55% specificity in indicating pathologically defined MT. In G2 Astro, initial gross total resection delayed MT (HR = 0.50, = .02) and predicted better overall survival (OS) (HR = 0.34, = .009). In G2 Oligo, spontaneous MT occurred earlier than treated MT (HR = 11.43, = .0002), but treatment did not predict improved OS ( = .8). MT patients ( = 126) exhibited worse OS than non-MT patients ( = 67) in All (HR = 2.54, = .0009) and G2 Astro (HR = 4.26, = .02).
Our study expands the understanding of MT to improve mutant lower-grade glioma management.
低级别突变型胶质瘤患者常发生恶性转化（MT），预后明显较差。许多研究在混合状态队列中研究MT，并使用影像学而非组织病理学来定义MT。我们的研究在一个大型的、仅为突变型的队列中，研究病理确定的MT的时间、预测因素和预后意义。
我们在加州大学洛杉矶分校确定了193例接受多次手术的突变型低级别胶质瘤患者。我们研究了病理确定的MT患者的结局。
2级少突胶质细胞瘤（G2 Oligo）发生MT的时间比2级星形细胞瘤（G2 Astro）长（风险比[HR]=0.46，P=.0007）。在逐步MT（G2到G3到G4 Astro）患者中，3级星形细胞瘤（G3 Astro）到4级星形细胞瘤（G4 Astro）的间隔时间比初始G3 Astro患者短（P=.03）。新出现的对比增强在提示病理定义的MT方面，阳性预测率为65%，阴性预测率为67%，敏感性为75%，特异性为55%。在G2 Astro中，初始肉眼全切可延迟MT（HR=0.50，P=.02），并预测总生存期（OS）更好（HR=0.34，P=.009）。在G2 Oligo中，自发MT比经治疗的MT出现更早（HR=11.43，P=.0002），但治疗并不能预测OS改善（P=.8）。在所有患者（HR=2.54，P=.0009）和G2 Astro患者（HR=4.26，P=.02）中，MT患者（n=126）的OS比非MT患者（n=67）差。
我们的研究扩展了对MT的认识，以改善突变型低级别胶质瘤的管理。
