Putamen involvement and survival outcomes in patients with insular low-grade gliomas
Putamen involvement and survival outcomes in patients with insular low-grade gliomas
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DOI：
10.3171/2016.5.jns1685
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发表时间：
2017-06-01
影响因子：
4.1
通讯作者：
Jiang, Tao
中科院分区：
文献类型：
--
作者：
Wang, Yongheng;Wang, Yinyan;Jiang, Tao
目的 岛状胶质瘤具有独特的起源和生物学行为；然而，其解剖特征和预后之间的关联尚未明确。本研究的目的是根据术前 MRI 结果提出岛叶低级别胶质瘤的分类系统，并评估该系统与生存结果的相关性。方法对连续收集的 211 例诊断为低级别岛状胶质瘤的患者进行分析。根据MR图像上肿瘤是否累及壳核对所有患者进行分类。使用多变量分析检查了这种新的壳核分类以及 Yasargil 分类的预后作用。结果 99 例 (46.9%) 岛叶胶质瘤累及壳核。与非壳核肿瘤相比，涉及壳核的肿瘤更大（p < 0.001），与癫痫病史相关的可能性较小（p = 0.04），更有可能具有野生型 IDH1（p = 0.003），并且不太可能被完全切除（p = 0.02）。单变量分析对总生存率的显着有利预测因素包括术前卡诺夫斯基功能量表评分高（p = 0.02）、癫痫病史（p = 0.04）、大体全切除（p = 0.006）、非壳核肿瘤（p < 0.001）和 IDH1 突变（p < 0.001）。在多变量分析中，切除范围 (p = 0.035)、壳核分类 (p = 0.014) 和 IDH1 突变 (p = 0.026) 是总生存期的独立预测因子。未发现 Ya argil 分类具有预后作用。 结论 目前的研究结果表明，壳核分类是岛叶低级别胶质瘤患者生存结果的独立预测因子。这种新提出的分类可以对岛状胶质瘤患者进行术前生存预测。
OBJECTIVE Insular glioma has a unique origin and biological behavior; however, the associations between its anatomical features and prognosis have not been well established. The object of this study was to propose a classification system of insular low-grade gliomas based on preoperative MRI findings and to assess the system's association with survival outcome.METHODS A total of 211 consecutively collected patients diagnosed with low-grade insular gliomas was analyzed. All patients were classified according to whether tumor involved the putamen on MR images. The prognostic role of this novel putaminal classification, as well as that of Yasargil's classification, was examined using multivariate analyses.RESULTS Ninety-nine cases (46.9%) of insular gliomas involved the putamen. Those tumors involving the putamen, as compared with nonputaminal tumors, were larger (p < 0.001), less likely to be associated with a history of seizures (p = 0.04), more likely to have wild-type IDH1 (p = 0.003), and less likely to be totally removed (p = 0.02). Significant favorable predictors of overall survival on univariate analysis included a high preoperative Karnofsky Performance Scale score (p = 0.02), a history of seizures (p = 0.04), gross-total resection (p = 0.006), nonputaminal tumors (p < 0.001), and an IDH1 mutation (p < 0.001). On multivariate analysis, extent of resection (p = 0.035), putamen classification (p = 0.014), and IDH1 mutation (p = 0.026) were independent predictors of overall survival. No prognostic role was found for Ya argil's classification.CONCLUSIONS The current study's findings suggest that the putamen classification is an independent predictor of survival outcome in patients with insular low-grade gliomas. This newly proposed classification allows preoperative survival prediction for patients with insular gliomas.