Effect of IDH mutation on postoperative temozolomide chemotherapy and prognosis in anaplastic gliomas: a single-center retrospective study of 285 patients
Objective To analyze the correlation between isocitrate dehydrogenase( IDH) mutation and clinicopathological factors in patients with anaplastic gliomas and its effect on the sensitivity of postoperative chemotherapy. Methods The patients from the Chinese Glioma Genome Atlas( CGGA) database who underwent craniotomy, were pathologically diagnosed as anaplastic glioma( WHO Grade Ⅲ), and received radiotherapy and/ or temozolomide( TMZ) chemotherapy after surgery were retrospectively consecutively included. Tumor tissue samples were obtained by surgical resection before radiotherapy and / or chemotherapy. Genomic DNA was extracted from frozen tumor tissue by QIAamp DNA mini kit according to the instructions. The concentration and quality of DNA were determined by MD-1000 spectrophotometer. IDH1/2 mutation, 1p/19q deletion and Mgmt promoter methylation were detected. SPSS 16.0 software was used to analyze the correlation between clinical and molecular pathological factors and overall survival, and the effect on the sensitivity of postoperative radiotherapy and temozolomide chemotherapy. Kaplan-Meier curve survival analysis was performed using GraphpadPrism 8 software. Results A total of 285 patients with anaplastic gliomas were included. Among them, 201( 70.5%) showed IDH mutation and 84( 29.5%) showed IDH wild. Multivariate Cox regression analysis showed that IDH mutation( HR=0.531, 95%CI: 0.385-0.733,P<0.001) and 1p / 19q deletion( HR=0.352, 95%CI: 0.179-0.691,P=0.002) were both independent predictors of overall survival, while the predictive value of O6 methylguanine DNA methyltransferase( MGMT) promoter methylation had no significant difference (P=0.071). In IDH mutation group, the prognosis of patients receiving TMZ chemotherapy was improved, but the difference was not statistically significant( median survival: 1 793 d vs 1 455 d, P=0.059). In IDH wild group, TMZ chemotherapy did not significantly improve the prognosis( median survival: 535 d vs 415 d, P=0.890). Conclusions In this study, it is found that the prognosis of IDH mutant anaplastic glioma after TMZ chemotherapy was improved, but the difference was not statistically significant. The relevant results may provide ideas for the future research of who grade Ⅲ glioma postoperative chemotherapy.
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杨沛 王宽宇 张传宝 王政 游赣 单侠.间变脑胶质瘤中异柠檬酸脱氢酶突变对患者术后替莫唑胺化学 治疗及预后的影响:285例单中心回顾性研究[J].神经疾病与精神卫生,2021,21(5): DOI :10.3969/j. issn.1009-6574.2021.05.004.