Abstract
The association of overall survival (OS) with tumor burden, including contrast enhanced (CE) volume on CE T1-weighted images, fluid-attenuated inversion recovery (FLAIR) hyperintense volume, and 3, 4-dihydroxy-6-[18F]-fluoro-L-phenylalanine (FDOPA) hypermetabolic volume, in isocitrate dehydrogenase (IDH) wild-type gliomas remains unclear. This study aimed to assess the association between biological tumor burden in pre- and post-operative status and OS in IDH wild-type gliomas, and evaluated which volume was the best predictor of OS. Thirty-four patients with treatment-naïve IDH wild-type gliomas (WHO grade II 6, III 15, IV 13) were retrospectively included. Three pre-operative tumor regions of interest (ROIs) were segmented based on the CE, FLAIR hyperintense, and FDOPA hypermetabolic regions. Resected ROIs were segmented from the post-operative images. Residual CE, FLAIR hyperintense, and FDOPA hypermetabolic ROIs were created by subtracting resected ROIs from pre-operative ROIs. Cox regression analysis was conducted to investigate the association of OS with the volume of each ROI, and Akaike information criterion was used to assess the fitness. Residual CE volume had a significant association with OS [hazard ratio (HR) = 1.26, p = 0.039], but this effect disappeared when controlling for tumor grade. Residual FDOPA hypermetabolic volume best fit the regression model and was significantly associated with OS (HR = 1.18, p = 0.008), even when controlling for tumor grade. FLAIR hyperintense volume showed no significant association with OS. Residual FDOPA hypermetabolic burden predicted OS for IDH wild-type gliomas, regardless of the tumor grade. Furthermore, removing hypermetabolic and CE regions may improve the prognosis.
Highlights
In 2016, the World Health Organization (WHO) classification of Tumors of the Central Nervous System reclassified gliomas by integrating molecular status, such as isocitrate dehydrogenase (IDH) gene mutation and chromosomal 1p/19q co-deletion 1
The Akaike information criterion (AIC) remained lower for residual FDOPA hypermetabolic volume than residual CE volume when controlling for clinical information, indicating that residual FDOPA hypermetabolic volume is a better predictor of overall survival (OS)
This study evaluated whether the tumor burden, including pre- or post-operative CE, fluid-attenuated inversion recovery (FLAIR) hyperintensity, or FDOPA hypermetabolic volume, was associated with OS in IDH wild-type gliomas
Summary
In 2016, the World Health Organization (WHO) classification of Tumors of the Central Nervous System reclassified gliomas by integrating molecular status, such as isocitrate dehydrogenase (IDH) gene mutation and chromosomal 1p/19q co-deletion 1. Approximately 90% of glioblastomas are IDH wild-type, whereas the remaining 10% are IDH mutant 2. About 30% of grade II and III gliomas are IDH wild-type, whereas the remaining 70% are IDH mutant [3,4]. Treatment methods vary depending on patient prognostic factors, including histology, tumor grade, age at diagnosis, Karnofsky performance status, first presenting symptom, extent of resection, and tumor size and location, as well as the molecular status, the standard treatment for patients with newly diagnosed high-grade gliomas remains surgical resection followed by radiotherapy in combination with the DNA-alkylating agent temozolomide 3. Regardless of tumor grade, patients with IDH wild-type gliomas present with a median overall survival (OS) < 2 years, which is significantly shorter than that of IDH mutant gliomas 4. The BTV for glioblastomas with postoperative pre-radio-chemotherapy and for recurrent high-grade gliomas were reported to be a significant predictor of OS 7–11
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