Velocity of tumor spontaneous expansion predicts long-term outcomes for diffuse low-grade gliomas

摘要: Supratentorial hemispheric diffuse low-grade gliomas (LGGs), referred to as World Health Organization grade II gliomas,1,2 are a heterogeneous group of tumors with distinct clinical, histological, and molecular characteristics. Diffuse affect young adults3 characterized by slow tumor growth,4 even in the silent period,5 transformation higher malignancy, leading neurological disability and, ultimately, death.6,7 Early maximal safe resection while preserving eloquent brain areas use perioperative functional monitoring is currently considered first-line treatment option.3,8 Indeed, there growing trend that extent significant prognostic factor for malignant progression-free survival overall among patients LGG.7,9,10 The anatomical distribution LGG can be visualized on conventional magnetic resonance imaging (MRI) using T2-weighted or fluid attenuated inversion recovery sequences.11 The subtle changes over time reflect macroscopic growth. They easily misdiagnosed stable abnormalities qualitative analyses should quantified. In this way, measurement velocity diametric expansion, estimated from mean diameter time, reliably quantify growth.12,13 It has previously been reported LGGs demonstrate spontaneous expansion 4 mm/year before after surgical resection.4,14 Of interest, oncological predict outcomes response chemotherapy radiotherapy.15–17 Spontaneous also biological underpinnings LGG.16,18 Taken together, suggests at histological diagnosis may help predicting natural history LGG. vary considerably literature. These wide ranges prognosis heterogeneity could explained, least part, limitations diagnosis.6 Molecular marker assessment, particularly 1p19q codeletion, p53 expression, isocitrate dehydrogenase mutation, improved accuracy refined prognosis.19 addition, was shown represent an independent parameter clinical ≥8 were similar those gliomas.6 Thus, promising tool behavior individual patients. This pioneer study addressed only significance categorical variable subset 143 LGGs.6 appears logical is, worse are. not related markers but add supplemental information. However, no previous had (i) continuous predictor survival and (ii) relationships between expansion. The aim present address these specific questions determining, large patient population, whether predictive long-term supratentorial adults, including survival, known