Zhao Chongshun, Liang Bo, Li Xiaopeng, Ma Peiheng, Li Yiming, Qian Zenghui, Zhang Zhong, Jiang Tao, Zhang Wei
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, PR China.
Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, 100070, PR China.
J Neurooncol. 2025 Jul 1. doi: 10.1007/s11060-025-05144-4.
BACKGROUND: Adult-type diffuse gliomas, particularly IDH-wildtype glioblastoma, exhibit significant differences in incidence across brain regions, with the occipital lobe being the rarest location. However, whether occipital glioblastoma differs from tumour in other regions in terms of prognosis and biological characteristics remains poorly understood. METHODS: This study included a total of 7,583 adult-type diffuse glioma patients from the SEER database, two public glioma datasets (UCSF-PDGM and UPENN-GBM), and a private dataset (Beijing Tiantan Hospital). For imaging data, Tumour location was classified using the USCLobes atlas, and white matter Tract Density Index (TDI) was computed to assess structural infiltration. Survival analyses employed Cox models and propensity score matching (PSM), adjusting for age, resection extent, and other confounders. RESULTS: The occipital lobe was the least common location for adult-type diffuse glioma (p < 0.001). Multivariable analysis adjusting for extent of resection and other confounders demonstrated that occipital tumours retained a significant survival advantage (adjusted HR = 0.82, 95% CI: 0.69-0.97, p = 0.019), corroborated in PSM cohorts (median OS 14 vs. 13 months, p = 0.012) and validated across independent datasets (HR = 0.73, 95% CI: 0.55-0.97, p = 0.027). Occipital glioblastoma exhibited lower TDI (p < 0.001). CONCLUSION: Occipital glioblastoma represents a distinct clinical entity associated with improved survival outcomes. This survival advantage may be attributed to reduced white matter tract infiltration. Future research should focus on the differences in biological characteristics and treatment strategies of gliomas at different locations.
背景：成人型弥漫性胶质瘤，尤其是异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤，在不同脑区的发病率存在显著差异，枕叶是最罕见的发病部位。然而，枕叶胶质母细胞瘤在预后和生物学特征方面是否与其他区域的肿瘤不同，仍知之甚少。 方法：本研究共纳入了来自监测、流行病学和最终结果（SEER）数据库的7583例成人型弥漫性胶质瘤患者、两个公共胶质瘤数据集（加州大学旧金山分校精准诊断胶质母细胞瘤数据集和宾夕法尼亚大学胶质母细胞瘤数据集）以及一个私人数据集（北京天坛医院）。对于影像数据，使用美国加利福尼亚大学脑叶图谱对肿瘤位置进行分类，并计算白质纤维束密度指数（TDI）以评估结构浸润情况。生存分析采用Cox模型和倾向评分匹配（PSM），并对年龄、切除范围和其他混杂因素进行了调整。 结果：枕叶是成人型弥漫性胶质瘤最不常见的发病部位（p < 0.001）。在对切除范围和其他混杂因素进行调整的多变量分析中，显示枕叶肿瘤具有显著的生存优势（调整后的风险比[HR] = 0.82，95%置信区间[CI]：0.69 - 0.97，p = 0.019），这在PSM队列中得到了证实（中位总生存期分别为14个月和13个月，p = 0.012），并在独立数据集中得到验证（HR = 0.73，95% CI：0.55 - 0.97，p = 0.027）。枕叶胶质母细胞瘤的TDI较低（p < 0.001）。 结论：枕叶胶质母细胞瘤是一种具有独特临床特征且生存结局较好的疾病。这种生存优势可能归因于白质纤维束浸润减少。未来的研究应聚焦于不同部位胶质瘤的生物学特征和治疗策略的差异。
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