异柠檬酸脱氢酶（IDH）突变型星形细胞瘤在2年内出现的早期进展性疾病可能提示放射性坏死。

Early progressive disease within 2 years in isocitrate dehydrogenase (IDH)-mutant astrocytoma may indicate radiation necrosis.

作者信息

Ozeki Yukie, Honda-Kitahara Mai, Yanagisawa Shunsuke, Takahashi Masamichi, Ohno Makoto, Miyakita Yasuji, Kikuchi Miu, Nakano Tomoyuki, Hosoya Tomohiro, Sugino Hirokazu, Satomi Kaishi, Yoshida Akihiko, Igaki Hiroshi, Kubo Yuko, Ichimura Koichi, Suzuki Hiromichi, Masutomi Kenkichi, Kondo Akihide, Narita Yoshitaka

机构信息

Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Tokyo, Japan.

Department of Neurosurgery and Neuro-Oncology, National Cancer Center Hospital, Tokyo, Japan.

出版信息

Jpn J Clin Oncol. 2025 Feb 4;55(2):106-112. doi: 10.1093/jjco/hyae151.

DOI:10.1093/jjco/hyae151

PMID:39660448

Abstract

BACKGROUND

Isocitrate dehydrogenase-mutant astrocytoma without cyclin-dependent kinase inhibitor 2A/B (CDKN2A/B) homozygous deletion typically follows a slow clinical course. However, some cases show early progression on magnetic resonance imaging, and these characteristics remain under-reported. This study aimed to elucidate the characteristics of isocitrate dehydrogenase-mutant astrocytoma showing early progression on magnetic resonance imaging.

METHODS

This retrospective study included 52 cases of primary astrocytoma, isocitrate dehydrogenase-mutant, Central Nervous System (CNS) 5 World Health Organization grade 2-3 according to the World Health Organization 2021 classification. Patients underwent surgery followed by radiation therapy and/or chemotherapy at our institution from 2006 to 2019. Progression-free survival and overall survival were analyzed.

RESULTS

There were 24 and 28 grade 2 and grade 3 astrocytomas, respectively. The median patient age was 38 years. Forty-three patients underwent radiotherapy. Progression was diagnosed by magnetic resonance imaging in 22 patients with initial radiotherapy. Thirteen of the 22 patients underwent surgery, and seven of the 13 patients received surgery within 24 months of the initial radiotherapy. Histopathologically, radiation necrosis was confirmed in four of these seven patients (57.1%). The true progression-free survival rate, excluding radiation necrosis, at 2 years after surgery was 91.3% for grade 2 astrocytoma and 88.5% for grade 3 astrocytoma. The 5-year overall survival rate was 85.7% for grade 2 tumours and 76.4% for grade 3 tumours.

CONCLUSIONS

Radiation necrosis should be considered in cases showing early progression of isocitrate dehydrogenase-mutant astrocytoma, and a second surgery should be performed to confirm true recurrence or radiation necrosis. Astrocytomas with telomerase reverse-transcriptase promoter mutations may relapse relatively early and should be followed up with caution.

摘要

背景

异柠檬酸脱氢酶突变型星形细胞瘤若无细胞周期蛋白依赖性激酶抑制剂2A/B（CDKN2A/B）纯合缺失，通常临床病程进展缓慢。然而，部分病例在磁共振成像上显示早期进展，而这些特征仍未得到充分报道。本研究旨在阐明在磁共振成像上显示早期进展的异柠檬酸脱氢酶突变型星形细胞瘤的特征。

方法

本回顾性研究纳入了52例原发性星形细胞瘤病例，根据世界卫生组织2021年分类标准，这些病例为异柠檬酸脱氢酶突变型，中枢神经系统（CNS）5级，世界卫生组织2级至3级。2006年至2019年期间，患者在本机构接受了手术，随后接受了放疗和/或化疗。分析了无进展生存期和总生存期。

结果

分别有24例2级星形细胞瘤和28例3级星形细胞瘤。患者的中位年龄为38岁。43例患者接受了放射治疗。22例初始接受放疗的患者通过磁共振成像诊断为病情进展。22例患者中有13例接受了手术，其中13例患者中有7例在初始放疗后24个月内接受了手术。组织病理学检查证实，这7例患者中有4例（57.1%）为放射性坏死。排除放射性坏死因素后，2级星形细胞瘤术后2年的真实无进展生存率为91.3%，3级星形细胞瘤为88.5%。2级肿瘤的5年总生存率为85.7%，3级肿瘤为76.4%。