• Neurosurgery · May 2019

    Impact of H3.3 K27M Mutation on Prognosis and Survival of Grade IV Spinal Cord Glioma on the Basis of New 2016 World Health Organization Classification of the Central Nervous System.

    • Seong Yi, Sunkyu Choi, Dong Ah Shin, Du Su Kim, Junjeong Choi, Yoon Ha, Keung Nyun Kim, Chang-Ok Suh, Jong Hee Chang, Se Hoon Kim, and YoonDo HeumDHDepartment of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea..
    • Department of Neurosurgery; Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
    • Neurosurgery. 2019 May 1; 84 (5): 1072-1081.

    BackgroundSpinal cord glioma grade IV is a rare, diffuse midline glioma. H3 K27M-mutant was classified in a different entity in the 2016 World Health Organization (WHO) classification recently. No reports about prognosis of spinal cord glioma grade IV are available yet.ObjectiveTo analyze the prognostic factors for spinal cord glioma grade IV.MethodsTwenty-five patients with spinal cord glioma of grade IV who underwent surgery in a single institute were selected. All grade IV spinal cord glioma histologically confirmed as glioblastoma or "diffuse midline glioma with H3 K27M-mutant" by the 2016 WHO classification of the central nervous system were included. Basic demographics, treatment modalities, and pathological tumor molecular profiles were investigated for prognosis.ResultsMean age was 39.1 yr; male to female ratio was 18 : 7. Tumor was located in thoracic cord (53.3%), cervical cord (40%), and lumbar area (6.7%). Median overall survival was 37.1 mo; median disease-free survival was 18.5 mo. Treatment modality showed no statistical difference. Only K27M profile showed significant prognostic value, 20 patients (80%) showed K27M mutation positive, K27M mutation patients showed longer overall survival (40.07 mo) than K27M negative patients (11.63 mo, P < .0001), and disease-free survival (20.85 vs 8.72 mo, P = .0241).ConclusionThis study is the first and largest report of the prognosis of primary spinal cord grade IV glioma using the new WHO classification. This study reported survival analysis and prognostic factors, and revealed that H3.3 K27M mutation is not a major poor prognostic factor. Further studies to explore K27M mutations needed for risk stratification and therapy optimization.Copyright © 2018 by the Congress of Neurological Surgeons.

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