Neuro-radiological characteristics of adult diffuse grade II and III insular gliomas classified according to WHO 2016
The phenotypic heterogeneity of diffuse gliomas is still inconsistently explained by known molecular abnormalities. Here, we report the molecular and radiological features of diffuse grade WHO II and III gliomas involving the insula and its potential impact on prognosis.
Clinical, pathological, molecular and neuro-radiological features of 43 consecutive patients who underwent a surgical resection between 2006 and 2013 for a grade II and III gliomas involving the insula was retrospectively analyzed.
Median age was 44.4 years. Eight patients had oligodendrogliomas, IDH mutant (IDHmut) and 1p/19q-codeleted (6 grade II, 2 grade III). Twenty-eight patients had diffuse astrocytomas, IDHmut (22 grade II and 6 grade III) and seven patients had grade II diffuse astrocytomas, IDHwt (A-IDHwt). Vimentin staining was exclusively recorded in tumor cells from A-IDHwt (p = 0.001). Mean cerebral blood volume (CBV) (p = 0.018), maximal value of CBV (p = 0.017) and ratio of the corrected CBV (p = 0.022) were lower for A-IDHwt. Volumetric segmentation of ADC allowed the identification of the tumor cores, which were smaller in A-IDHwt (p < 0.001). The tumor occurrences of A-IDHwt were exclusively located into the temporo-insular region. Median progression-free survival (PFS) and overall survival (OS) were 50.9 months (95% CI: 26.7–75.0) and 80.9 months (60.1–101.6). By multivariate analysis, A-IDHwt (p = 0.009; p = 0.019), 7p gain and 10q loss (p = 0.009; p = 0.016) and vimentin positive staining (p = 0.011; p = 0.029) were associated with poor PFS and OS respectively.
Insular low-grade A-IDHwt presented with poor prognosis despite a smaller tumor core and no evidence of increased perfusion on MR imaging.
KeywordsGlioma Insula Perfusion Molecular Neuro-radiology
This work was supported by grants from Institut National du Cancer (Grant No. INCa-DGOS-Inserm 6038), from the Cancéropôle PACA (Grant No. 2015-02 INSUL802) and the GEFLUC Marseille Provence (Groupement Entreprises Françaises Lutte contre le Cancer—PVM-2014-241). We thank the AP-HM Tumor Bank (Authorization Number: AC2018-31053; CRB BB-0033-00097) for providing tissue samples. We also thank the ARTC-Sud patients’s association (Association pour le Recherche sur les Tumeurs Cérébrales).
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 5.van den Bent MJ, Brandes AA, Taphoorn MJB et al (2013) Adjuvant procarbazine, lomustine, and vincristine chemotherapy in newly diagnosed anaplastic oligodendroglioma: long-term follow-up of EORTC brain tumor group study 26951. J Clin Oncol Off J Am Soc Clin Oncol 31:344–350. https://doi.org/10.1200/JCO.2012.43.2229 CrossRefGoogle Scholar
- 22.Jiang H, Cui Y, Wang J, Lin S (2017) Impact of epidemiological characteristics of supratentorial gliomas in adults brought about by the 2016 world health organization classification of tumors of the central nervous system. Oncotarget 8:20354–20361. https://doi.org/10.18632/oncotarget.13555 Google Scholar
- 26.Gaiano N, Fishell G (2002) The role of notch in promoting glial and neural stem cell fates. Annu Rev Neurosci 25:471–490. https://doi.org/10.1146/annurev.neuro.25.030702.130823 CrossRefGoogle Scholar