H3K27M and<i>TERT</i>promoter mutations are poor prognostic factors in surgical cases of adult thalamic high-grade glioma

Osada, Yuko; Saito, Ryuta; Shibahara, Ichiyo; Sasaki, Keisuke; Shoji, Taku; Kanamori, Masayuki; Sonoda, Yukihiko; Kumabe, Toshihiro; Watanabe, Mika; Tominaga, Teiji

doi:10.1093/noajnl/vdab038

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…In the series of Park et al, [17] where 70% of the patient group consisted of patients with KPS 80 and above, the median overall survival was 21.8 months. In accordance with Park's findings, Osada et al [4] published the results of 12 H3K27M-mutant glioma patients, where 58.3% of the patients with KPS 80 and above, with a median OS of 22.8 months. Our analysis has demonstrated that patients with a KPS score of 50 are associated with a worse prognosis compared to higher KPS scores.…”

Section: Discussionsupporting

confidence: 67%

“…Radiotherapy, with or without chemotherapy, is frequently the only effective option for patients with unresected or partially resected tumors, [3] with reported median survival times ranging between 8.76 and 22.8 months in the literature. [4,5] We retrospectively evaluated the results of radiotherapy with or without temozolomide for adult patients with H3K27M-altered midline gliomas.…”

Section: Introductionmentioning

confidence: 99%

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Radiotherapy Outcomes in Adults with H3K27MAltered Midline Gliomas and Poor Performance Status

Koçak Uzel

2024

Comprehensive Med

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Objective: Treatment of H3K27M-altered midline gliomas is a significant challenge. This study aims to assess the efficacy of radiotherapy for these patients. Materials and Methods:Thirteen patients with histologically confirmed H3K27M-altered midline glioma, treated with radiotherapy +/-temozolomide between 2019 and 2021, were retrospectively analyzed. Clinical and radiological responses, survival times, and prognostic factors were evaluated. All patients were treated with hypofractionated radiotherapy, with a dose of 25-40 Gy. Results:The median age was 42 years (ranging from 19 to 55). Karnofsky Performance Status scores ranged from 50 to 70, with a median score of 50. Hypofractionated radiotherapy was administered to all patients, with 25 Gy given in 5 fractions to 7 patients (53.8%), 39 Gy in 13 fractions to 3 patients (23.1%), and 40 Gy in 15 fractions to 3 patients (23.1%). Clinically, two patients (15.4%) showed symptomatic improvement, five patients (38.8%) remained stable, and six patients (46.2%) had neurological deterioration. Radiologically, one patient had a partial response, six patients (46.2%) had stable disease, and radiological progression occurred in three patients (23.1%). The median progression-free survival and median overall survival time were 123 and 154 days, respectively. Karnofsky Performance Status 50 was associated with a worse prognosis. Conclusion:These results suggest that the efficacy of radiotherapy might be limited for adults with H3K27M-altered midline gliomas with poor performance status. New studies are necessary for a more comprehensive understanding of effective therapeutic strategies.

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Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

confidence: 99%

Radiotherapy Outcomes in Adults with H3K27MAltered Midline Gliomas and Poor Performance Status

Koçak Uzel

2024

Comprehensive Med

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“…The prognosis of DMG patients with H3K27M alterations is poor, with a median survival period reported in the literature between 8.76 and 22.8 months [8][9][10]. The 2-year survival rate is less than 10% for patients receiving standard treatment, including surgery and adjuvant chemoradiation [11].…”

Section: Introductionmentioning

confidence: 99%

Deep Learning for the Prediction of the Survival of Midline Diffuse Glioma with an H3K27M Alteration

Huang,

Chen,

Zhang

et al. 2023

Brain Sciences

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Background: The prognosis of diffuse midline glioma (DMG) patients with H3K27M (H3K27M-DMG) alterations is poor; however, a model that encourages accurate prediction of prognosis for such lesions on an individual basis remains elusive. We aimed to construct an H3K27M-DMG survival model based on DeepSurv to predict patient prognosis. Methods: Patients recruited from a single center were used for model training, and patients recruited from another center were used for external validation. Univariate and multivariate Cox regression analyses were used to select features. Four machine learning models were constructed, and the consistency index (C-index) and integrated Brier score (IBS) were calculated. We used the receiver operating characteristic curve (ROC) and area under the receiver operating characteristic (AUC) curve to assess the accuracy of predicting 6-month, 12-month, 18-month and 24-month survival rates. A heatmap of feature importance was used to explain the results of the four models. Results: We recruited 113 patients in the training set and 23 patients in the test set. We included tumor size, tumor location, Karnofsky Performance Scale (KPS) score, enhancement, radiotherapy, and chemotherapy for model training. The accuracy of DeepSurv prediction is highest among the four models, with C-indexes of 0.862 and 0.811 in the training and external test sets, respectively. The DeepSurv model had the highest AUC values at 6 months, 12 months, 18 months and 24 months, which were 0.970 (0.919–1), 0.950 (0.877–1), 0.939 (0.845–1), and 0.875 (0.690–1), respectively. We designed an interactive interface to more intuitively display the survival probability prediction results provided by the DeepSurv model. Conclusion: The DeepSurv model outperforms traditional machine learning models in terms of prediction accuracy and robustness, and it can also provide personalized treatment recommendations for patients. The DeepSurv model may provide decision-making assistance for patients in formulating treatment plans in the future.

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“…This was a retrospective study reviewing the medical records of patients with supratentorial adult diffuse gliomas and thalamic DMG who underwent debulking surgeries at our department between January 2009 and December 2022 [ 12 , 13 , 16 , 26 , 29 , 31 ]. The follow-up data until June 2023 were analyzed.…”

Section: Methodsmentioning

confidence: 99%

Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases

Kanamori,

Morishita,

Shimoda

et al. 2024

Acta Neurochir

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Background Distant recurrence can occur by infiltration along white matter tracts or dissemination through the cerebrospinal fluid (CSF). This study aimed to clarify the clinical features and mechanisms of recurrence in the dentate nucleus (DN) in patients with supratentorial gliomas. Based on the review of our patients, we verified the hypothesis that distant DN recurrence from a supratentorial lesion occurs through the dentato-rubro-thalamo-cortical (DRTC) pathway. Methods A total of 380 patients with supratentorial astrocytoma, isocitrate dehydrogenase (IDH)-mutant (astrocytoma), oligodendroglioma, IDH mutant and 1p/19q-codeleted (oligodendroglioma), glioblastoma, IDH-wild type (GB), and thalamic diffuse midline glioma, H3 K27-altered (DMG), who underwent tumor resection at our department from 2009 to 2022 were included in this study. Recurrence patterns were reviewed. Additionally, clinical features and magnetic resonance imaging findings before treatment, at the appearance of an abnormal signal, and at further progression due to delayed diagnosis or after salvage treatment of cases with recurrence in the DN were reviewed. Results Of the 380 patients, 8 (2.1%) had first recurrence in the DN, 3 were asymptomatic when abnormal signals appeared, and 5 were diagnosed within one month after the onset of symptoms. Recurrence in the DN developed in 8 (7.4%) of 108 cases of astrocytoma, GB, or DMG at the frontal lobe or thalamus, whereas no other histological types or sites showed recurrence in the DN. At the time of the appearance of abnormal signals, a diffuse lesion developed at the hilus of the DN. The patterns of further progression showed that the lesions extended to the superior cerebellar peduncle, tectum, tegmentum, red nucleus, thalamus, and internal capsule along the DRTC pathway. Conclusion Distant recurrence along the DRTC pathway is not rare in astrocytomas, GB, or DMG at the frontal lobe or thalamus. Recurrence in the DN developed as a result of the infiltration of tumor cells through the DRTC pathway, not dissemination through the CSF.

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H3K27M andTERTpromoter mutations are poor prognostic factors in surgical cases of adult thalamic high-grade glioma

Cited by 6 publications

References 30 publications

Radiotherapy Outcomes in Adults with H3K27MAltered Midline Gliomas and Poor Performance Status

Radiotherapy Outcomes in Adults with H3K27MAltered Midline Gliomas and Poor Performance Status

Deep Learning for the Prediction of the Survival of Midline Diffuse Glioma with an H3K27M Alteration

Distant recurrence in the cerebellar dentate nucleus through the dentato-rubro-thalamo-cortical pathway in supratentorial glioma cases

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