A single-institution retrospective study of multicentric gliomas stratified by IDH mutational status

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Abstract
Background: Multicentric glioma (MCG) are defined radiographically as two or more tumor foci with separation of MRI T2-FLAIR (T2-weighted Fluid-attenuated Inversion Recovery) hyperintensities presenting synchronously (sMCG) and/or metachronously (mMCG). Previous studies have not stratified isocitrate dehydrogenase (IDH) wild-type and mutant gliomas by sMCG and mMCG. In this large, single-institution cohort stratified by IDH status, we evaluated MCG prevalence, prognostic implications, time to mMCG (TtM), location, and pathological concordance. Methods: We identified 836 IDH wild-type and 531 IDH mutant diffuse glioma patients treated at our institution with evaluable MRI. We inspected MRIs at presentation for sMCG and subsequent imaging for mMCG, reviewed radiology and pathology reports, and performed overall survival (OS) and TtM analyses. Results: MCG prevalence was higher in IDH wild-type cases (18%) than in IDH mutant cases (9%) (P < .0001). We found 20 sMCG and 26 mMCG in IDH mutant and 91 sMCG and 54 mMCG in IDH wild-type patients. In 7 wild-type and 1 mutant instances, mMCG arose from sMCG (smMCG). While sMCG and mMCG were associated with lower OS in IDH wild-type cases (sMCG: HR = 1.46, P = .003; mMCG: HR = 1.44, P = .02), only mMCG was associated with lower OS in IDH mutant cases (sMCG: HR = 1.22, P = .7; mMCG: HR = 2.64, P = .001). IDH wild-type cases had shorter TtM than mutant cases (P < .0001). Among double-biopsied MCG, pathology discordance occurred in 5/7 mutant but 0/28 wild-type cases. Conclusion: Results from this cohort of diffuse gliomas stratified by IDH status showed differences between IDH wild-type and mutant cohorts in prevalence, prognosis, TtM, distribution, and pathological concordance.
Funding Information
  • Bradley Zankel Foundation and National Institutes of Health (NIH)/National Cancer Institute (P50 CA211015-01A1)
  • NIH/NCI (R01CA270027)
  • NIH/NCI (R01CA279984)
  • Department of Defense (DOD) CDMRP (CA220732)
  • Sontag Foundation
  • National Brain Tumor Society

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