Artikel
Is ALA-induced fluorescence a novel and independent biomarker of inherent malignant degeneration in low-grade gliomas?
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Approximately only a small fraction of low-grade gliomas (LGGs) displays visible PPIX fluorescence during surgery, after 5-ALA administration. We wanted to determine if PPIX positive LGGs differed in prognosis from non-PPIX positive LGGs and whether this was reflected by molecular factors, which are known to correlate with LGG.
Method: We retrospectively analyzed 78 consecutive cases of LGG, operated on with 5-ALA, between 1/10 and 1/16, as documented in our prospective glioma data base. IDH1 (R132H)-mutation status, Ki67/MIB1, tumor size, patient-age, KPS and contrast-enhancement were assessed and related to time to malignant deterioration (TMD).
Results: Median follow-up was 32 months (95% CI: 23.1-32.8). 21 (16%) of 78 LGG patients showed PP IX fluorescence. The Ki67/MIB1-index was the same for fluorescing and non-fluorescing tumors (4,03 vs. 5,05, p= 0,23). No significant relation was observed between fluorescence and IDH1. TMD was significantly shorter in IDH1 wild type tumors compared to mutated tumor (46,4 vs. 60.1 months, P=0.028). Independently, TMD in ALA positive LGG, was significantly shorter than in ALA negative tumors (38.0 to 58.0 months, p =0.026). No differences in age, KPS, tumor size or contrast-enhancement were found.
Conclusions: ALA induced PPIX fluorescence appears to be a marker of inherent malignant degeneration, independent of know prognostic patient characteristics of tumor molecular factors.