Xiao Yao, Nie Zhuang, Huang Jinsha, Zhao Jie, Dong Chengjun, Zou Yan, Li Zikai, Yan Bingqing, Hu Yue, Yang Fan, Lee Jong Woo, Lin Alexander P, Tobochnik Steven, Zhou Min, Lei Ziqiao
Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
Hubei Provincial Clinical Research Center for Precision Radiology & Interventional Medicine, Wuhan, China.
Brain Behav. 2025 May;15(5):e70510. doi: 10.1002/brb3.70510.
The relevance of tumor-related epilepsy (TRE) to glioma survival is controversial. This study aimed to assess the risk factors and prognostic impact of TRE in adult patients with diffuse gliomas by integrating clinical, radiological, and molecular data.
This multicenter retrospective study included 1036 adult patients with diffuse gliomas from local hospitals and the POLA Network. Patients were categorized into three prognostic groups: lower-grade oligodendroglioma/astrocytoma (OD/AC, II-III, IDH-MT), not otherwise specified or not elsewhere classified (NOS/NEC, II-III, IDH-WT), and high-grade gliomas (HGG, IV). Clinico-radiological, molecular, and therapeutic factors were analyzed using univariate and multivariate logistic regression, with the Cox proportional hazards model applied to identify independent prognostic factors for progression-free survival (PFS) and overall survival (OS).
TRE occurred in 44.4% of OD/AC patients, 25.8% of NOS/NEC patients, and 16.5% of HGG patients. Multivariate analysis identified age as the only significant independent correlate of TRE in the OD/AC group (OR = 0.961; p = 0.004), while the absence of deep structure involvement was independently associated with TRE in the NOS/NEC and HGG groups. In univariate analysis, the presence of TRE was associated with longer PFS and OS across all groups, particularly in the NOS/NEC group, where patients with TRE had a median PFS of 35.2 months compared to 13.6 months in those without TRE (p = 0.02), but was not a significant predictor in multivariate analyses. TRE was the only factor significantly associated with maintaining histological grade at recurrence (HR = 0.094; p = 0.005).
TRE was not a strong independent prognostic factor after controlling for clinical and molecular tumor features, suggesting that the prognostic relevance of TRE is likely driven by underlying glioma biology and other associated clinical factors.
肿瘤相关性癫痫（TRE）与胶质瘤生存期的相关性存在争议。本研究旨在通过整合临床、放射学和分子数据，评估TRE在成年弥漫性胶质瘤患者中的危险因素及预后影响。
这项多中心回顾性研究纳入了来自当地医院和POLA网络的1036例成年弥漫性胶质瘤患者。患者被分为三个预后组：低级别少突胶质细胞瘤/星形细胞瘤（OD/AC，II - III级，异柠檬酸脱氢酶突变型，IDH-MT）、未另作说明或未另行分类（NOS/NEC，II - III级，异柠檬酸脱氢酶野生型，IDH-WT）和高级别胶质瘤（HGG，IV级）。使用单因素和多因素逻辑回归分析临床放射学、分子和治疗因素，并应用Cox比例风险模型确定无进展生存期（PFS）和总生存期（OS）的独立预后因素。
OD/AC组44.4%的患者发生TRE，NOS/NEC组为25.8%，HGG组为16.5%。多因素分析确定年龄是OD/AC组中TRE唯一显著的独立相关因素（OR = 0.961；p = 0.004），而在NOS/NEC组和HGG组中，未累及深部结构与TRE独立相关。单因素分析中，TRE的存在与所有组的PFS和OS延长相关，尤其是在NOS/NEC组，有TRE的患者中位PFS为35.2个月，无TRE的患者为13.6个月（p = 0.02），但在多因素分析中不是显著的预测因素。TRE是与复发时维持组织学分级显著相关的唯一因素（HR = 0.094；p = 0.005）。
在控制临床和分子肿瘤特征后，TRE不是一个强有力的独立预后因素，这表明TRE的预后相关性可能由潜在的胶质瘤生物学特性和其他相关临床因素驱动。
