Clinical updates on gliomas and implications of the 5th edition of the WHO classification of central nervous system tumors

Abstract

BackgroundThe 5th edition of the World Health Organization (WHO) classification of central nervous system tumors incorporated specific molecular alterations into the categorization of gliomas. The major revision of the classification scheme effectuates significant changes in the diagnosis and management of glioma. This study aimed to depict the clinical, molecular, and prognostic characteristics of glioma and its subtypes according to the current WHO classification.MethodsPatients who underwent surgery for glioma at Peking Union Medical College Hospital during 11 years were re-examined for tumor genetic alterations using next-generation sequencing, polymerase chain reaction-based assay, and fluorescence in situ hybridization methods and enrolled in the analysis.ResultsThe enrolled 452 gliomas were reclassified into adult-type diffuse glioma (ntotal=373; astrocytoma, n=78; oligodendroglioma, n=104; glioblastoma, n=191), pediatric-type diffuse glioma (ntotal=23; low-grade, n=8; high-grade, n=15), circumscribed astrocytic glioma (n=20), and glioneuronal and neuronal tumor (n=36). The composition, definition, and incidence of adult- and pediatric-type gliomas changed significantly between the 4th and the 5th editions of the classification. The clinical, radiological, molecular, and survival characteristics of each subtype of glioma were identified. Alterations in CDK4/6, CIC, FGFR2/3/4, FUBP1, KIT, MET, NF1, PEG3, RB1, and NTRK2 were additional factors correlated with the survival of different subtypes of gliomas.ConclusionsThe updated WHO classification based on histology and molecular alterations has updated our understanding of the clinical, radiological, molecular, survival, and prognostic characteristics of varied subtypes of gliomas and provided accurate guidance for diagnosis and potential prognosis for patients.

Clinical roles of EGFR amplification in diffuse gliomas: a real-world study using the 2021 WHO classification of CNS tumors

“…605 patients with glioma, resected or biopsied between January 2011 and January 2022 at the Department of Neurosurgery at Peking Union Medical College Hospital (PUMCH), were screened for this study ( Guo et al, 2023 ). Exclusion criteria were: (i) age under 18 years; (ii) missing data for diagnostic molecular markers (i.e., IDH1/2 mutation, CDKN2A/B mutation, 1p/19q codeletion, TERT promoter mutation, EGFR amplification and combined whole chromosome 7 gain and whole chromosome 10 loss); (iii) circumscribed astrocytic gliomas, glioneuronal and neuronal tumors and ependymal tumors according to the 2021 WHO classification of CNS tumors.…”

Targeted Glioma Therapy—Clinical Trials and Future Directions

“…For low-grade gliomas, the optimal treatment involves immediate surgical resection of the tumor to avoid further cancer progression and allow precise molecular characterization of the tumor [ 20 ], which is indeed crucial for the development of a treatment plan for any glioma [ 2 , 10 , 11 ]. For high-risk cohorts of low-grade-glioma-diagnosed patients (age > 40 years; patients who do not undergo gross total resection surgery [ 21 ]), postoperative care consists of 50–54 Gy radiotherapy followed by adjuvant therapy with DNA-alkylating or cytostatic agents.…”

Deeper insight into ferroptosis: association with Alzheimer’s, Parkinson’s disease, and brain tumors and their possible treatment by nanomaterials induced ferroptosis

“…On the basis of histopathology and degree of proliferation, glioma could be further subdivided into 4 subtypes and grades (I to IV) [ 264 ]. Grade IV glioma is commonly known as Glioblastoma [ 265 ]. GBS is a very common, invasive, aggressive, and undifferentiated type of malignant brain tumor, whose annual occurrence is 3.2 for every 100,000 persons [ 266–268 ].…”