Alexandre Roux1,2,3, Arnault Tauziede-Espariat2,3,4, Marc Zanello1,2,3, Sophie Peeters5, Gilles Zah-Bi1,2,3, Eduardo Parraga1,2,3, Myriam Edjlali2,3,6, Emmanuèle Lechapt2,3,4, Natalia Shor7, Luisa Bellu8, Giulia Berzero8, Didier Dormont7, Edouard Dezamis1,2,3, Fabrice Chretien2,3,4,9, Catherine Oppenheim2,3,6, Marc Sanson8, Pascale Varlet2,3,4, Laurent Capelle10, Frédéric Dhermain11, Johan Pallud1,2,3. 1. Department of Neurosurgery, University Hospital Group for Psychiatry and Neurosciences (GHU)-Sainte-Anne Hospital, Paris, France. 2. Paris Descartes University, Sorbonne Paris Cité, Paris, France. 3. INSERM Unit 1266, Imaging Biomarkers of Brain Disorders (IMA-BRAIN), Institute of Psychiatry and Neurosciences of Paris, Paris, France. 4. Department of Neuropathology, GHU-Sainte-Anne Hospital, Paris, France. 5. Department of Neurosurgery, University of California Los Angeles, Los Angeles, California, USA. 6. Department of Neuroradiology, GHU-Sainte-Anne Hospital, Paris, France. 7. Department of Neuroradiology, Pitié-Salpêtrière Hospital, Paris, France. 8. Department of Neuro-Oncology, Pitié-Salpêtrière Hospital, Paris, France. 9. Laboratory of Experimental Neuropathology, Pasteur Institute, Paris, France. 10. Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France. 11. Department of Radiotherapy, Gustave Roussy University Hospital, Villejuif, France.
Abstract
BACKGROUND: We quantified the spontaneous imaging growth rate of oligodendrogliomas. We assessed whether (i) it discriminates between World Health Organization (WHO) grade II and grade III oligodendrogliomas, and (ii) grade III oligodendrogliomas with neo-angiogenesis are associated with more fast growth rates (≥8 mm/y). METHODS: This work employed a retrospective bicentric cohort study (2010-2016) of adult patients harboring a newly diagnosed supratentorial oligodendroglioma, isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (WHO 2016 classification), with a minimum of 2 available MRIs before any treatment (minimum 6-week interval) to measure the spontaneous tumor growth rate. RESULTS: We included 108 patients (age 44.7 ± 14.1 y, 60 males). The tumor growth rate was higher in grade III oligodendrogliomas with neo-angiogenesis (n = 37, median 10.4 mm/y, mean 10.0 ± 6.9) than in grade III oligodendrogliomas with increased mitosis count only (cutoff ≥6 mitoses, n = 18, median 3.9 mm/y, mean 4.5 ± 3.2; P = 0.004), and higher than in grade II oligodendrogliomas (n = 53, median 2.3 mm/y, mean 2.8 ± 2.2; P < 0.001). There was increased prevalence of fast tumor growth rates in grade III oligodendrogliomas with neo-angiogenesis (54.1%) compared with grade III oligodendrogliomas with increased mitosis count only (11.1%; P < 0.001), and in grade II oligodendrogliomas (0.0%; P < 0.001). The tumor growth rate trends did not differ between centers (P = 0.121). Neo-angiogenesis (P < 0.001) and mitosis count at ≥9 (P = 0.013) were independently associated with tumor growth rates ≥8 mm/year. A tumor growth rate ≥8 mm/year was the only predictor independently associated with shorter progression-free survival (P = 0.041). CONCLUSIONS: The spontaneous tumor growth rate recapitulates oligodendroglioma aggressiveness, permits identification of grade III oligodendrogliomas preoperatively when ≥8 mm/year, and questions the grading by mitosis count.
BACKGROUND: We quantified the spontaneous imaging growth rate of oligodendrogliomas. We assessed whether (i) it discriminates between World Health Organization (WHO) grade II and grade III oligodendrogliomas, and (ii) grade III oligodendrogliomas with neo-angiogenesis are associated with more fast growth rates (≥8 mm/y). METHODS: This work employed a retrospective bicentric cohort study (2010-2016) of adult patients harboring a newly diagnosed supratentorial oligodendroglioma, isocitrate dehydrogenase (IDH) mutant and 1p/19q codeleted (WHO 2016 classification), with a minimum of 2 available MRIs before any treatment (minimum 6-week interval) to measure the spontaneous tumor growth rate. RESULTS: We included 108 patients (age 44.7 ± 14.1 y, 60 males). The tumor growth rate was higher in grade III oligodendrogliomas with neo-angiogenesis (n = 37, median 10.4 mm/y, mean 10.0 ± 6.9) than in grade III oligodendrogliomas with increased mitosis count only (cutoff ≥6 mitoses, n = 18, median 3.9 mm/y, mean 4.5 ± 3.2; P = 0.004), and higher than in grade II oligodendrogliomas (n = 53, median 2.3 mm/y, mean 2.8 ± 2.2; P < 0.001). There was increased prevalence of fast tumor growth rates in grade III oligodendrogliomas with neo-angiogenesis (54.1%) compared with grade III oligodendrogliomas with increased mitosis count only (11.1%; P < 0.001), and in grade II oligodendrogliomas (0.0%; P < 0.001). The tumor growth rate trends did not differ between centers (P = 0.121). Neo-angiogenesis (P < 0.001) and mitosis count at ≥9 (P = 0.013) were independently associated with tumor growth rates ≥8 mm/year. A tumor growth rate ≥8 mm/year was the only predictor independently associated with shorter progression-free survival (P = 0.041). CONCLUSIONS: The spontaneous tumor growth rate recapitulates oligodendroglioma aggressiveness, permits identification of grade III oligodendrogliomas preoperatively when ≥8 mm/year, and questions the grading by mitosis count.
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