Departments of1Neurosurgery.
2Department of Neurosurgery, Weill Cornell Medical Center, New York, New York.
J Neurosurg. 2023 Aug 11;140(2):367-376. doi: 10.3171/2023.6.JNS222907. Print 2024 Feb 1.
Isocitrate dehydrogenase (IDH) mutations in both high- and low-grade gliomas are associated with an increase in survival compared with IDH-wild-type (IDHwt) tumors. A rare and understudied population is elderly individuals, ≥ 65 years of age, who have IDH1-R132H-mutant (IDHmt) gliomas. The objective of this paper was to characterize the institutions' experience with IDHmt gliomas in a patient population ≥ 65 years of age over the last 10 years.
A retrospective study of individuals ≥ 65 years of age with IDHmt gliomas treated between 2010 and 2020 at Memorial Sloan Kettering was performed.
Twenty-five patients ≥ 65 years of age underwent resection or biopsy with a diagnosis of IDHmt glioma (52% WHO grade II, 32% WHO grade III, and 16% WHO grade IV). The most common presenting symptoms were seizure (28%) and motor or sensory deficits (24%). On preoperative MRI, 56% of tumors demonstrated contrast enhancement and 44% had no enhancement. Most patients underwent craniotomy for resection (n = 23, 92%), with subtotal resection achieved in the majority (16/23, 69.6%). Postoperative discharge location included home (64%), acute rehabilitation (16%), subacute rehabilitation (8%), and unknown (12%). Most patients received postoperative chemotherapy (72%) and radiation therapy (68%). The 2- and 5-year survival rates for the overall cohort were 83.1% (95% CI 69.3%-99.7%) and 69.7% (95% CI 53.2%-91.3%), respectively, with gross-total resection or near-total resection, contrast enhancement, and WHO grade significantly associated with survival. From the clinical sequencing data, no significant differences were identified between younger and older IDHmt cohorts.
While IDH mutation in elderly patients may be rare, these patients have favorable survival relative to their IDHwt counterparts. Age at diagnosis should not be used in isolation to suggest a molecular IDHwt status or poor prognosis when guiding patient treatment decisions.
与 IDH 野生型（IDHwt）肿瘤相比，高低级别胶质瘤中的异柠檬酸脱氢酶（IDH）突变与生存时间延长相关。一个研究较少的罕见人群是年龄在 65 岁及以上、携带 IDH1-R132H 突变（IDHmt）的胶质瘤患者。本文的目的是描述过去 10 年中，在年龄≥65 岁的患者中，医疗机构在 IDHmt 胶质瘤方面的经验。
对 2010 年至 2020 年期间在 Memorial Sloan Kettering 接受 IDHmt 胶质瘤切除术或活检的年龄≥65 岁的个体进行回顾性研究。
25 名年龄≥65 岁的患者被诊断为 IDHmt 胶质瘤（52%为 WHO 分级 II 级，32%为 WHO 分级 III 级，16%为 WHO 分级 IV 级）。最常见的首发症状为癫痫发作（28%）和运动或感觉障碍（24%）。术前 MRI 显示，56%的肿瘤增强，44%的肿瘤无强化。大多数患者接受了开颅切除术（n=23，92%），其中大部分为次全切除术（16/23，69.6%）。术后出院地点包括家中（64%）、急性康复（16%）、亚急性康复（8%）和未知（12%）。大多数患者接受了术后化疗（72%）和放疗（68%）。全队列的 2 年和 5 年生存率分别为 83.1%（95%CI 69.3%-99.7%）和 69.7%（95%CI 53.2%-91.3%），肿瘤全切或近全切、增强对比和 WHO 分级与生存显著相关。从临床测序数据来看，年轻和年长的 IDHmt 队列之间没有发现显著差异。
尽管老年患者的 IDH 突变可能较为罕见，但与 IDHwt 患者相比，这些患者的生存情况较好。在指导患者治疗决策时，不应仅凭年龄来确定 IDHwt 状态或预测不良预后。
