Article
Subventricular zone involvement is associated with unfavourable outcome in glioma of WHO grade II
Infiltration der subventrikulären Zone ist mit schlechterem Outcome in Gliomen WHO Grad II assoziiert
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Authors
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Philipp Karschnia
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
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Jonathan Weller
- Massachusetts General Hospital Cancer Center, Department of Neurology, Boston/MA, Vereinigte Staaten
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Jens Blobner
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
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Veit M. Stoecklein
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
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Mario M. Dorostkar
- Ludwig-Maximilians-Universität München, Zentrum für Neuropathologie und Prionenforschung, München, Deutschland
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Kai D. Rejeski
- Ludwig-Maximilians-Universität München, Medizinische Klinik und Polyklinik 3, München, Deutschland
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Robert Forbrig
- Ludwig-Maximilians-Universität München, Institut für Neuroradiologie, München, Deutschland
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Maximilian Niyazi
- Ludwig-Maximilians-Universität München, Klinik für Strahlentherapie und Radioonkologie, München, Deutschland
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Louisa von Baumgarten
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
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Jorg Dietrich
- Massachusetts General Hospital Cancer Center, Department of Neurology, Boston, Vereinigte Staaten
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Jörg Christian Tonn
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
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Niklas Thon
- Ludwig-Maximilians-Universität München, Klinik für Neurochirurgie, München, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: The subventricular zone represents the largest niche of adult neural stem cells. Involvement of the subventricular zone is associated with less favourable outcome in malignant glioma. It is unclear whether a similar association applies to low-grade gliomas.
Methods: We retrospectively searched our institutional database for patients with glioma WHO grade II according to the 2016 classification. Demographics, histological and molecular information, imaging, and therapeutic approaches were reviewed and outcome was analysed for gliomas with and without infiltration of the subventricular zone.
Results: We identified 182 patients with glioma WHO grade II, including 97 oligodendrogliomas and 85 astrocytomas. Subventricular zone involvement was present in 78 of 182 patients (43%). Neither demographics, histopathology, nor molecular signature including MGMT promotor status and IDH mutation status differed between patients with and without subventricular zone involvement. First-line management included early therapeutic approaches (surgery, chemotherapy, radiotherapy, or brachytherapy) or wait-and-scan approaches. Median follow-up was 43 months. Median time to malignant progression as determined per tissue-based analysis was 122 months; median overall survival was not reached. Subventricular zone involvement was a negative prognostic marker for both time to malignant progression (p= 0.002) and overall survival (p= 0.023) in the entire cohort, but also in the subgroup of patients who were managed with wait-and-scan approaches. This also held true when patients were stratified according to tumor size. Among patients in which early therapy was provided, subventricular zone involvement was not prognostic for overall survival. In multivariate analysis, subventricular zone involvement was associated with worse prognosis independent of molecular markers or treatment approaches including use of resection.
Conclusion: Subventricular zone involvement represents a key risk factor for worse outcome in glioma WHO grade II which might be independent from molecular markers or tumor size. Early first-line therapy may form the basis for favourable outcome in such patients.
