Found this interesting article - and even though it is quite old (2008) and only involves a small cohort of AA3 patients for it´s statistics, I still found it interesting.
In most, especially recent, articles the main focus is on either pathology (mitosis count, proliferative index etc) or on molecular constitution of the tumors - or at least the combination.
This article is interesting because it also focusses on the anatomy of the tumors - particular enhancement and - even more important - resection degree and growth pattern of the tumor.
And if you look at survival statistics - even though from a small cohort - in the article there seems to be quite some interesting viewports in analysis of the anatomy of the tumors.
https://onlinelibrary.wiley.com/doi/pdf/10.1002/jmri.21593
This article was of course before the WHO 2016 definitions and it doesn´t concern itself with the further diomensions of e.g. IDH, methylation ATRX etc. That would probably add some explanation to some of the quite dramatic differences in OS in the cohort.
Any thoughts on this aspect of tumor anatomy or other interesting studies to the subject?
Any study of AA that doesn't include IDH1 status is to a degree obselete. Because in many cases the prognostic value of those other variables might be due to their being associated with a given IDH1 status. For example, AA patients with IDH1 mutation are more likely to be younger, undergo gross total resections, and also likely have specific growth patterns versus IDH1 non-mutant tumors.
ReplyDeleteDuring the first months to a year after my friends diagnosis I was preoccupied with pinning down a prognosis for her, but that doesn't concern me much anymore. My primary job now is to make those prognostications wrong, by doing as much as possible therapy-wise.
The 2016 inclusion of IDH1 in the definition of diffuse gliomas was a huge step forward. Tumors that used to be all lumped together as "anaplastic astrocytoma" are now recogized as being two different diseases. Anaplastic astrocytoma without IDH mutation is in reality usually a glioblastoma in an earlier stage of evolution, or misdiagnosed as grade 3 due to sampling error. I'm also of the opinion that IDH1 mutant astrocytomas that progress to grade IV should NOT be called "secondary glioblastomas". They would more properly be called grade 4 astrocytomas, and grade 3 gliomas with the molecular features of glioblastoma (chromosome 7 gain, chromosome 10 loss, and usually TERT promoter mutation) should be called "grade 3 glioblastoma". In other words I feel the term "glioblastoma" should be relative to genomic features and independent of tumor grade. Sorry, I kind of went off on a tangent from your original post.
New study looking at contrast enhancement as a variable within integrated up-to-date diagnosis including IDH1 status.
ReplyDeletehttps://www.ncbi.nlm.nih.gov/pubmed/29667086
If you'd like to read the full study I can upload to the Brain Tumor Library.
Oh, yes, please! It's very interesting!
DeleteI've uploaded it to the Pathology folder.
Delete