Journal Article

DKFZ-2023-00979

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Risk Estimation in Non-Enhancing Glioma: Introducing a Clinical Score.

Dao Trong, P. ; Kilian, S. ; Jesser, J. ; Reuss, D. ; Aras, F. K. ; von Deimling, A.DKFZ* ; Herold-Mende, C. ; Unterberg, A. ; Jungk, C.

2023
MDPI Basel

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Please use a persistent id in citations: doi:10.3390/cancers15092503

Abstract: The preoperative grading of non-enhancing glioma (NEG) remains challenging. Herein, we analyzed clinical and magnetic resonance imaging (MRI) features to predict malignancy in NEG according to the 2021 WHO classification and developed a clinical score, facilitating risk estimation. A discovery cohort (2012-2017, n = 72) was analyzed for MRI and clinical features (T2/FLAIR mismatch sign, subventricular zone (SVZ) involvement, tumor volume, growth rate, age, Pignatti score, and symptoms). Despite a 'low-grade' appearance on MRI, 81% of patients were classified as WHO grade 3 or 4. Malignancy was then stratified by: (1) WHO grade (WHO grade 2 vs. WHO grade 3 + 4) and (2) molecular criteria (IDHmut WHO grade 2 + 3 vs. IDHwt glioblastoma + IDHmut astrocytoma WHO grade 4). Age, Pignatti score, SVZ involvement, and T2/FLAIR mismatch sign predicted malignancy only when considering molecular criteria, including IDH mutation and CDKN2A/B deletion status. A multivariate regression confirmed age and T2/FLAIR mismatch sign as independent predictors (p = 0.0009; p = 0.011). A 'risk estimation in non-enhancing glioma' (RENEG) score was derived and tested in a validation cohort (2018-2019, n = 40), yielding a higher predictive value than the Pignatti score or the T2/FLAIR mismatch sign (AUC of receiver operating characteristics = 0.89). The prevalence of malignant glioma was high in this series of NEGs, supporting an upfront diagnosis and treatment approach. A clinical score with robust test performance was developed that identifies patients at risk for malignancy.

Keyword(s): CDKN2A/B ; IDH mutation ; lower-grade glioma ; malignant glioma ; molecular classification ; non-enhancing glioma ; prognostic score ; risk estimation

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Contributing Institute(s):

1. KKE Neuropathologie (B300)
2. DKTK HD zentral (HD01)

Research Program(s):

1. 312 - Funktionelle und strukturelle Genomforschung (POF4-312) (POF4-312)

Appears in the scientific report 2023

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