Impact of Surgical Ventricular Entry on Survival Outcomes in IDH-Mutant Gliomas.

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-09-18 DOI:10.1227/neu.0000000000003744

Neslihan Nisa Gecici, Ahmed Habib, Jan Drappatz, Megan Mantica, Kalil G Abdullah, Sameer Agnihotri, Pascal O Zinn

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引用次数: 0

Abstract

Background and objectives: Although some studies suggest ventricular entry (VE) is associated with complications and poor survival in glioblastoma, it remains unclear whether this association applies to isocitrate dehydrogenase (IDH)-mutant gliomas. This study evaluated the impact of VE on progression-free survival (PFS) and overall survival (OS) in these tumors.

Methods: A retrospective analysis of patients with supratentorial IDH-mutant gliomas, treated between 2006 and 2021 at the University of Pittsburgh Medical Center was performed. VE was identified through postoperative imaging review.

Results: A total of 231 patients were identified, with VE occurring in 32.9% (n = 76) of patients. During the study period, 64.9% of patients experienced disease progression, and 42.4% died. VE was associated with a higher rate of subependymal/ependymal enhancement (18.4% vs 3.2%, P < .001), leptomeningeal disease (6.6% vs 0.6%, P = .02) and, new distant foci development (18.4% vs 5.8% P = .006), shorter median OS (P [log-rank] <0.0001), and shorter median PFS (P < .0001). Multivariable analysis identified VE as an independent risk factor of decreased OS (HR: 2.1 [1.24-3.48], P = .005) and PFS (HR: 1.66 [1.13-2.44], P = .01), after adjusting for clinical, lesional, molecular factors, and subventricular zone contact.

Conclusion: This study indicates that VE is associated with poor survival outcomes in IDH-mutant gliomas. These findings warrant prospective studies to better understand the risks, benefits, and mitigation strategies of VE in glioma surgery. Understanding the ependymal physical barrier as well as, cellular biological effects of VE, and its role in glioma tumorigenesis may serve as a basis for potential therapeutic targets in the future management of these patients.

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手术进入脑室对idh突变胶质瘤患者生存结局的影响。

背景和目的：尽管一些研究表明，脑室进入（VE）与胶质母细胞瘤的并发症和较差的生存率相关，但尚不清楚这种关联是否适用于异柠檬酸脱氢酶（IDH）突变的胶质瘤。本研究评估了VE对这些肿瘤的无进展生存期（PFS）和总生存期（OS）的影响。方法：回顾性分析2006年至2021年在匹兹堡大学医学中心治疗的幕上idh突变胶质瘤患者。通过术后影像学检查确定VE。结果：共发现231例患者，其中VE发生率为32.9% （n = 76）。在研究期间，64.9%的患者出现疾病进展，42.4%的患者死亡。VE与较高的室管膜下/室管膜增强率（18.4% vs 3.2%, P < 0.001）、轻脑膜疾病（6.6% vs 0.6%, P = 0.02）和新的远端病灶发展（18.4% vs 5.8% P = 0.006）、较短的中位生存期（P [log-rank]）相关。这些发现支持前瞻性研究，以更好地了解VE在胶质瘤手术中的风险、益处和缓解策略。了解室管膜物理屏障、VE的细胞生物学效应及其在胶质瘤发生中的作用，可以作为未来治疗这些患者的潜在治疗靶点的基础。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.