Survival Assessment Of After Treatment High Grade Glioma

Part 1 Newly enhancement beyond residual cavity improves survival prediction of patients with high grade glioma after treatmentObjective: High-grade glioma(HGG)still has a poor prognosis post standard treatment,The effect of enhancement beyond the residual cavity on prognosis is still inconclusive.We therefor explored weather the newly enhancement beyond residual cavity would improve the diagnostic efficacy for predicting survival state of patients with HGG after standard treatment following NCCN guide line.Methods:A total of 142 HGG patients were analyzed retrospectively.Newly found enhancement beyond the residual cavity,including new subventricular zone enhancement(n SVZE)and new distal enhancement lesions(n DELs),as well as other conventional MR features and clinical factors,were included in univariate analysis.Then multivariate analysis was used for evaluating the prognostic role of various factors on progression free survival(PFS)and overall survival(OS).Receiver operating characteristic curve(ROC)was performed to compare the diagnostic efficacy when n SVZE and n DELs were added to other prognostic factors.Results: The median follow up was 24 months(21-28).The median PFS was 345 days(382-538)and OS was 540 days(561-720),respectively.Univariate analysis showed that histological grade(P=0.008),n DELs(P=0.0001),n SVZE(P<0.0001)were the poor prognostic factors for PFS.Similarly,histological grade(P=0.017),n DELs(P<0.0001),n SVZE(P<0.0001)were poor prognostic factors for OS.With multivariate analysis,we found that n SVZE(P<0.0001)were the poor prognostic factors for PFS.However,n DELs(P<0.0001),n SVZE(P<0.0001)were the poor prognostic factors for OS.When n DELs and n SVZE added to combined diagnostic model,we got highest AUC(0.940)and specificity(0.922)for survival evaluation.Conclusions:Our results suggest that the newly enhancement beyond residual cavity,including n SVZE and n DELs,improve the survival prognostic prediction efficacy of patients with HGG after standard treatment.The n SVZE and n DELs lesions were easy to identified in conventional follow-up MR practice.Part 2 MRI findings and prognosis of after treatment HGG: impacts of IDH mutation statusObjective: Previous studies have proved that the IDH mutation gliomas are different from wild type gliomas in preoperative MRI manifestations and prognosis,but few studies have been conducted after treatment.The purpose of this study was to observe the differences of postoperative MRI manifestations between IDH mutant and wild type HGG,and whether it affected the survival assessment after treatment.Methods:The conventional MRI findings and clinical data of 70 patients of after treatment HGG were retrospectively analyzed,MRI signs included the variation trend of nonenhancing(T2/FLAIR)lesions,enhancement pattern of residual cavity,new distal enhancement(n DE),new subventricular zone enhancement(n SVZE)and whether the diffusion limitation of DWI.The clinical data included age,gender,histopathological grading and tumor location.Univariate analysis was used to evaluate the differences of phenotype parameters of different IDH genes.Receiver operating characteristic curve(ROC)was performed to evaluate the prognosis efficacy of IDH gene phenotype and various factors combined on after treatment HGG.Results: The median follow-up time of 70 cases of HGG was 19(16-23)months,of which 26 cases of IDH mutant and 44 cases of IDH wild type.The PFS and OS of IDH wild type HGG patients were significantly shorter than IDH mutant(median PFS 10/17 months,median OS 13/22.5 months).The proportion of grade IV was lower(43.2%),while that of n DE(43.2%)and n SVZE(52.3%)were higher in IDH wild type HGG,however,the proportion of grade IV was higher(69.2%),while that of n DE(23.1%)and n SVZE(26.9%)were lower in IDH mutant,the difference between them was significant(P=0.035,P=0.010,P=0.038),and other parameters had no statistical difference.In 34 cases of DWI examination showed that IDH wild type diffusion restriction(n=16/23,69.6%)were more than mutant(n=5/11,45.5%)(P=0.262).ROC showed that the combined diagnosis model including age,histopathological grading,n DE,n SVZE and IDH gene phenotype(AUC=0.922),it was better than other single factor or other postoperative MRI morphology and clinical factor combined model(AUC=0.583-0.855).Conclusions:The two signs,including n DE and n SVZE,are more common in after treatment HGG patients with IDH wild type.Adding IDH mutation status can improve the efficacy of survival assessment of after treatment HGG by MRI imaging signs.