第五版《世界卫生组织中枢神经系统肿瘤分类指南》下成人胶质瘤诊断及预后

Diagnosis and Prognosis of Adult Glioma According to The Fifth Edition of WHO Classification of Tumors of The Central Nervous System

目的脑胶质瘤是最常见的恶性原发性中枢神经系统肿瘤,近年来分子病理的快速发展对胶质瘤诊断及分级带来了重要影响,在2021年发布的《世界卫生组织中枢神经系统肿瘤分类指南》(第五版)引入了更多分子指标对肿瘤的诊断和分级进行指导。本研究旨在临床队列中比较最新版指南和上一版指南对肿瘤诊断及预后评估的影响,以期为临床实践活动中新版指南的应用提供数据参考和依据。方法回顾性纳入了癌症基因组图谱数据库512例胶质瘤样本,分别依据2016版和2021版《世界卫生组织中枢神经系统肿瘤分类指南》进行诊断、通过Kaplan-Meier进行生存曲线绘制和中位总生存期计算和生存差异分析。结果对512例样本分别完成了上一版指南和最新版指南的诊断及分级。在新版指南下分别有53和72例异柠檬酸脱氢酶(IDH)突变型和IDH野生型的胶质瘤诊断级别升级为了4级,且这些诊断级别升高的胶质瘤的预后更差。结论最新版指南较上一版指南可对胶质瘤进行更为精准地分类及分级,在有条件的情况下应尽快依据最新版指南开展诊断及分级。

Objective Glioma is the most common malignant primary tumor of the central nervous system.Recently,the rapid development of molecular pathology has brought an important influence on the diagnosis and classification of gliomas.The latest version of the World Health Organization(WHO)Classifications of The Central Nervous System Tumors(fifth edition)published in 2021 has introduced more molecular features to guide the diagnosis and classification of gliomas.The aim of this study was to provide evidence of the application of the latest version of WHO classification via comparing the fluences of the latest and the previous version of WHO classifications on tumor diagnosis and prognosis in a clinical cohort.Methods 512 glioma samples were retrospectively included in the cancer genome atlas database.The diagnosis was performed according to the latest(2021 edition)and the previous version(2016 edition)of WHO classifications,respectively.Kaplan-Meier curves were used to calculate median overall survival and analyze survival differences.Results We completed the diagnosis and grading of 512 cases by the latest(2021 edition)and the previous version(2016 edition)of WHO classifications,respectively.53 cases of IDH mutant tumors and 72 cases of IDH wildtype tumors were upgraded to grade 4 in the latest version(2021 edition)of the WHO classification.These tumors with elevated grades also had a worse prognosis.Conclusion Compared with the previous version,glioma can be classified and graded more accurately by the latest version(2021 edition)of the WHO classification.Diagnosis and grading should be performed according to the latest version as soon as possible.