Marino Salvatore, Menna Grazia, Doglietto Francesco, Quaranta Davide, Chiesa Silvia, Gaudino Simona, Russo Rosellina, Marziali Gianmaria, Galeazzi Marco, D'Alessandris Quintino Giorgio, Lauretti Liverana, Mattogno Pier Paolo, Di Bonaventura Rina, Caraglia Naike, Di Maio Lucia, Olivi Alessandro, Della Pepa Giuseppe Maria
Neurosurgery Unit, Department of Neurosciences, Catholic University School of Medicine, Rome, Italy.
Department of Neurosurgery, Mater Olbia Hospital, Olbia, 07026, Italy.
J Neurooncol. 2025 Jun 3. doi: 10.1007/s11060-025-05050-9.
High-grade gliomas (HGGs) are aggressive primary brain tumors with inevitable recurrence. This single-center retrospective study investigates whether the anatomical proximity of HGGs to major white matter tracts influences progression and recurrence. The study explores the association between tumor location and recurrence type-local, remote, or ependymal-and whether recurrences align with adjacent white matter tracts.
The study included patients with histopathologically confirmed recurrent HGGs who underwent reoperation. Primary tumors were categorized into four anatomical subgroups using a connectivity-based framework from the HCP 1065 Atlas: Subgroup A: Long Fronto-Temporo-Parietal Network Subgroup B: Temporal Pole Network (further divided into B1, B2, and B3 based on connectivity patterns) Subgroup C: Frontal Pole Network Subgroup D: Commissural and Projection Networks (further divided into D1 and D2). Recurrences were classified via post-contrast T1-weighted MRI as local, remote, ependymal. The Tract-to-Region Connectome (T-R-C) assessed the volumetric overlap between recurrence maps and main white matter bundles.
Of 41 patients, a significant correlation emerged between tumor subgroup and recurrence type (p = 0.0003). Subgroup A predominantly showed remote recurrences (68%), while B2, B3, C, and D2 had mainly local recurrences. Subgroup D1 had a predominance of ependymal recurrences (66.7%). Local and remote recurrences largely conformed to adjacent white matter distributions, with variations in timing of recurrence and survival observed across different groups.
Our analysis, focused on exploring the spatial aspects of recurrence in relation to white matter anatomy, suggests that HGG recurrence patterns are strongly influenced by anatomical location and white matter architecture. Certain anatomical areas show a predisposition toward specific recurrence patterns. Recognizing these spatial dynamics may guide more precise surgical strategies, radiotherapy targeting, and recurrence risk assessment.
高级别胶质瘤（HGGs）是具有不可避免复发的侵袭性原发性脑肿瘤。这项单中心回顾性研究调查了HGGs与主要白质束的解剖学邻近性是否会影响进展和复发。该研究探讨了肿瘤位置与复发类型（局部、远处或室管膜下）之间的关联，以及复发是否与相邻白质束一致。
该研究纳入了经组织病理学证实为复发性HGGs且接受再次手术的患者。使用来自HCP 1065图谱基于连通性的框架将原发性肿瘤分为四个解剖亚组：A组：长额颞顶网络；B组：颞极网络（根据连通性模式进一步分为B1、B2和B3）；C组：额极网络；D组：连合和投射网络（进一步分为D1和D2）。通过对比增强T1加权MRI将复发分类为局部、远处、室管膜下。轨迹到区域连接组（T-R-C）评估了复发图谱与主要白质束之间的体积重叠。
在41例患者中，肿瘤亚组与复发类型之间存在显著相关性（p = 0.0003）。A组主要表现为远处复发（68%），而B2、B3、C和D2主要为局部复发。D1组室管膜下复发占优势（66.7%）。局部和远处复发在很大程度上符合相邻白质分布，不同组间观察到复发时间和生存的差异。
我们专注于探索复发与白质解剖学相关的空间方面的分析表明，HGG复发模式受解剖位置和白质结构的强烈影响。某些解剖区域表现出对特定复发模式的易感性。认识到这些空间动态可能会指导更精确的手术策略、放疗靶向和复发风险评估。
