Study Of Biological Characteristic Of Insular Glioma And Prognosis Assessment Based On Molecular Pathology

Background and objective:Glioma is a malignant tumor that originates in the brain and usually affects the lobes of the hemisphere.Insula glioma is one of the most common type of glioma.The insula is located in the deep part of the Sylvian fissure,adjacent to the important blood vessels and nerve structures,and the anatomy is complex.Therefore,it is difficult to resect the insular glioma.It is sometimes difficult to take into account both the tumor resection and neurological protection,and many postoperative complications may occur.In the past decades,with the completion of the Human Genome Project and the development of gene sequencing technologies,a series of molecular markers involving genetic changes in tumors have been widely studied and applied.The molecular pathology features of the IDH1 mutation,MGMT promoter methylation,and 1p/19q co-deletion often reflect the biological characteristics of the tumor and its sensitiveness to treatment,providing the selection and development of glioma treatment options.A reliable and objective new basis.The newly published WHO Central Nervous System Tumor Guidelines in 2016 incorporated the molecular pathological features at the genetic alteration level for the first time into the diagnostic classification of gliomas,integrating histological and molecular biological phenotypes.We have been conducting molecular pathological examinations of gliomas since July 2014,and has accumulated some experience in the individual treatment of insular gliomas based on molecular pathology.Under this circumstances,this study aims to analyze whether the biological characteristics of insular gliomas and other parts of gliomas are similar or not based on molecular pathological indicators,and to explore the influence of this biological characteristics on the survival time of patients in order to further optimize Improve the diagnosis and treatment of insular glioma and judge its prognosis.In this two parts,the biological characteristics and prognosis of the two parts are described and explored from the molecular pathological indicators and the patient’s prognosis.Methods:137 cases of glioma patients were included from July 2014 to June 2017 in the Department of Neurosurgery of the General Hospital of PLA.The patient’ s gender,age,tumor location,preoperative KPS scores,and surgical methods were collected.The degree of tumor resection,postoperative radiotherapy and chemotherapy,and the 4 molecular marker indicators routinely performed after surgery in our hospital,including:IDH1 mutations,MGMT promoter methylation,lp/19q combined deletion,and BRAF gene mutation.Due to the originance and development,the clinical course,treatment plan and prognosis of the patients of low-grade glioma or high-grade gliomas are all significantly different.Therefore,this study will be divided into low-grade insular gliomas and high-grade insular gliomas.Differences in molecular pathology between groups were tested using chi-square test,p<0.05 was considered statistically significant.The Kaplan-Meier survival analysis was used for the survival analysis.The significance of the differences was tested using the log-rank method.The difference was statistically significant at p<0.05.Results:Among the different molecular pathology markers,patients with insular glioma showed higher rates of IDH1 mutation(71%)and methylation of MGMT promoter(76%)compared with patients with other sites of glioma.The intrinsic molecular pathological mechanism of insular glioma is different from other parts of glioma,and has its unique biological characteristics.In the low-grade glioma group,IDH1 mutation rate(90%)and MGMT promoter methylation rate(76%)were statistically significant in insular glioma patients.Insula patients had longer PFS(p=0.03)and OS(p=0.26);IDH1 mutation rate(58.8%)and MGMT promoter methylation in insular gliomas in high-grade gliomas The incidence(76.5%)was also statistically significant,and insular patients had longer PFS(p=0.04)and OS(p=0.02).Whether in low-grade or high-grade gliomas,patients with insular gliomas can have a longer progression-free survival and overall survival when they have IDH1 mutations and pathological changes in the MGMT methylation bimolecular.Conclusion:1.By comparing molecular pathological markers,the biological characteristics of insular gliomas are different from those of other origins.Insular tumors are often accompanied by IDH1 mutations and/or molecular pathological features of MGMT methylation.The characteristics of the study are good,the patient is sensitive to treatment,and the prognosis is good.The progression-free survival and overall survival are longer compared with the same-grade gliomas in other sites.2.Through the relationship between molecular pathological markers and patient survival time,changes in molecular pathology markers reflect the biological characteristics of the tumor,as an independent prognostic factor of survival time,can guide the treatment and prognosis.It is of great significance for individualized treatment of gliomas.