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한빛사논문
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박예원Yae Won Park
연세대학교 의과대학, 현 서울아산병원
Neuro-Oncology, May 02 2026, noag096 | https://doi.org/10.1093/neuonc/noag096
A comprehensive clinical, molecular, radiological, and surgical analysis for predicting prognosis in IDH-mutant astrocytoma patients
Minjee Cho 1, Minjin Kim 2, Hyeonjin Kim 3, Kaeum Choi 4, Kyunghwa Han 1, Sung Soo Ahn 1, Hong In Yoon 5, Jong Hee Chang 6, Se Hoon Kim 7, Seung-Koo Lee 1, Yae Won Park 1,8, Whitney B Pope 8
1Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
2Department of Computer Science, Sookmyung Women's University, Seoul, Korea.
3Department of Industrial Engineering, Yonsei University, Seoul, Korea.
4Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA.
5Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
6Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
7Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
8Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Corresponding author: Yae Won Park
1Department of Radiology and Research Institute of Radiological Science and Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, Korea.
2Department of Computer Science, Sookmyung Women's University, Seoul, Korea.
3Department of Industrial Engineering, Yonsei University, Seoul, Korea.
4Department of Biostatistics and Bioinformatics, Emory University, Atlanta, USA.
5Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Korea.
6Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea.
7Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.
8Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Corresponding author: Yae Won Park
Abstract
Background: To comprehensively investigate clinical, molecular, radiological, and surgical factors for prediction of progression-free survival (PFS) in patients with isocitrate dehydrogenase (IDH)-mutant astrocytomas.
Methods: A total of 210 patients with newly diagnosed WHO grade 2 to 4 IDH-mutant astrocytomas between 2005 and 2023 were included. Clinical, molecular, radiological, and surgical factors were evaluated. Total, contrast-enhancing, non-enhancing, and necrotic tumor volumes were quantified via automatic volumetric segmentation (cm3). Significant predictors of PFS were identified using univariable and multivariable Cox analyses.
Results: The median PFS was 106.8 months, with a 5-year PFS rate of 67.5%. On multivariable analysis, higher initial KPS (hazard ratio [HR] = 0.76, P = .029) remained as a favorable predictor of PFS, while higher WHO grade (grade 3, HR = 1.01, P = .997; grade 4, HR = 2.91, P = .013; reference standard as grade 2, overall P = .032), larger total tumor volume (HR = 1.03, P = .013), and lesser extent of resection (EOR) (subtotal resection, HR = 1.80, P = .043; partial resection, HR = 2.14, P = .014; biopsy, HR = 3.79, P = .008; reference standard as gross total resection, overall P = .015) remained as unfavorable predictors of PFS. Age and MGMT promoter methylation were not significant predictors, while the adverse prognostic impact of WHO grade was primarily driven by WHO grade 4 tumors.
Conclusions: Our work presents a detailed analysis of a large series of IDH-mutant astrocytomas, underscoring the prognostic importance of WHO grade 4, tumor volume, and EOR.
Methods: A total of 210 patients with newly diagnosed WHO grade 2 to 4 IDH-mutant astrocytomas between 2005 and 2023 were included. Clinical, molecular, radiological, and surgical factors were evaluated. Total, contrast-enhancing, non-enhancing, and necrotic tumor volumes were quantified via automatic volumetric segmentation (cm3). Significant predictors of PFS were identified using univariable and multivariable Cox analyses.
Results: The median PFS was 106.8 months, with a 5-year PFS rate of 67.5%. On multivariable analysis, higher initial KPS (hazard ratio [HR] = 0.76, P = .029) remained as a favorable predictor of PFS, while higher WHO grade (grade 3, HR = 1.01, P = .997; grade 4, HR = 2.91, P = .013; reference standard as grade 2, overall P = .032), larger total tumor volume (HR = 1.03, P = .013), and lesser extent of resection (EOR) (subtotal resection, HR = 1.80, P = .043; partial resection, HR = 2.14, P = .014; biopsy, HR = 3.79, P = .008; reference standard as gross total resection, overall P = .015) remained as unfavorable predictors of PFS. Age and MGMT promoter methylation were not significant predictors, while the adverse prognostic impact of WHO grade was primarily driven by WHO grade 4 tumors.
Conclusions: Our work presents a detailed analysis of a large series of IDH-mutant astrocytomas, underscoring the prognostic importance of WHO grade 4, tumor volume, and EOR.
논문소개전체 설명
본 연구에서는 최신 2021 WHO 중추신경계 종양 분류 체계를 적용하여 분자생물학적으로 정의된 WHO grade 2~4단계 IDH-mutant astrocytoma 환자 210명을 대상으로 정밀한 예후 분석을 수행하였다. 분석 결과, 종양 등급에 따른 예후 악화는 주로 Grade 4 상태에 의해 결정되었으며, Grade 2와 Grade 3 종양 간에는 생존 결과가 상호 유사하게 나타나 차기 WHO 등급 시스템 개정의 필요성을 뒷받침하였다. 또한, 전체 종양 부피와 종양 절제 범위(EOR)가 환자의 연령이나 MGMT promoter methylation 등 기존의 전통적 인자보다 무진행 생존(PFS)을 예측하는 데 훨씬 더 강력한 독립적 지표임을 규명하였다. 이는 정량적인 종양 부피가 단순한 조영 증강 유무보다 생물학적 공격성을 더욱 정확하게 반영하는 영상 바이오마커임을 시사하며, 특히 최근 주목받는 보라시데닙(Vorasidenib)과 같은 표적 IDH 억제제 치료 시 정교한 위험 층화의 근거가 될 수 있다. 결론적으로 본 연구는 맞춤형 신경종양학 시대를 맞아 정밀한 영상 분석을 통한 리스크 평가가 필수적임을 강조하고 있다.
논문정보
- Research article
- 2026년 05월 (BRIC 등록일 2026-05-07)
- 국내(교신)+국외 연구진
- 의약학 > 의약학 기타
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