Characterization and clinical implications of different malignant transformation patterns in diffuse low‐grade gliomas

Abstract

Malignant transformation (MT) of low‐grade gliomas (LGGs) to a higher‐grade variant seems inevitable, yet it remains unclear which LGG patients will progress to grade 3 or even directly to grade 4 after receiving a long course of treatment. To elucidate this, we conducted a retrospective cohort study based on 229 adults with recurrent LGG. Our study aimed to disclose the characteristics of different MT patterns and to build predictive models for patients with LGG. Patients were allocated into group 2–2 (n = 81, 35.4%), group 2–3 (n = 91, 39.7%), and group 2–4 (n = 57, 24.9%), based on their MT patterns. Patients who underwent MT showed lower Karnofsky performance scale (KPS) scores, larger tumor sizes, smaller extents of resection (EOR), higher Ki‐67 indices, lower rates of 1p/19q codeletion, but higher rates of subventricular involvement, radiotherapy, chemotherapy, astrocytoma, and post‐progression enhancement (PPE) compared with those in group 2–2 (p < 0.01). On multivariate logistic regression, 1p/19q codeletion, Ki‐67 index, radiotherapy, EOR, and KPS score were independently associated with MT (p < 0.05). Survival analyses demonstrated that patients in group 2–2 had the longest survival, followed by group 2–3 and then group 2–4 (p < 0.0001). Based on these independent parameters, we constructed a nomogram model that exhibited superior potential (sensitivity: 0.864, specificity: 0.814, and accuracy: 0.843) compared with PPE in early prediction of MT. Combining the factors of 1p/19q codeletion, Ki‐67 index, radiotherapy, EOR, and KPS score that were presented at initial diagnosis could precisely forecast the subsequent MT patterns of patients with LGG.

TBX15 facilitates malignant progression of glioma by transcriptional activation of TXDNC5

“…Gliomas are a type of cancerous tumor that commonly occur in the central nervous system and are considered the most common form of primary brain tumors of adults. 1 , 2 Its characteristics include a high degree of malignancy, rapid development, and broad invasive growth. 3 Despite advances in treatment strategies, the combination of surgical resection and targeted radiotherapy/chemotherapy can improve the overall survival of low-grade glioma to a certain extent; however, the prognosis of high-grade glioma remains exceedingly poor.…”

Case report: Temozolomide induced hypermutation indicates an unfavorable response to immunotherapy in patient with gliomas

“…Low-grade gliomas (LGG), classified as grades 1 and 2, typically exhibit an indolent clinical course but are susceptible to frequent relapses ( 2 ). Upon recurrence, LGG may progress to grade 3 or grade 4 variants, characterized by increased malignancy and a less favorable prognosis ( 3 ). Surgical resection serves as the primary therapeutic approach for LGG patients, aiming to alleviate clinical symptoms and extend survival ( 4 ).…”