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doi: https://doi.org/10.4132/jptm.2017.09.25    [Epub ahead of print]
Reclassification of Mixed Oligoastrocytic Tumors Using a Genetically Integrated Diagnostic Approach
Seong-Ik Kim1, Yujin Lee1,2, Jae-Kyung Won1, Chul-Kee Park2, Seung Hong Choi3, Sung-Hye Park1,4
1Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
2Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea
3Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
4Department of Neurosicence Institute, Seoul National University College of Medicine, Seoul, Korea
Corresponding Author: Sung-Hye Park ,Email: shparknp@snu.ac.kr
Received: July 17, 2017;  Revised: September 18, 2017  Accepted: September 25, 2017.  Published online: September 29, 2017.
Mixed gliomas, such as oligoastrocytomas (OA), anaplastic oligoastrocytomas, and glioblastomas with an oligodendroglial component (GBMO) are defined as tumors composed of a mixture of two distinct neoplastic cell types, astrocytic and oligodendroglial. Recently, mutations ATRX and TP53, and codeletion of 1p/19q are shown to be genetic hallmarks of astrocytic and oligodendroglial tumors, respectively. Subsequent molecular analyses of mixed gliomas preferred the reclassification to either oligodendroglioma or astrocytoma. This study was designed to apply genetically integrated diagnostic criteria to mixed gliomas and determine usefulness and prognostic value of new classification in Korean patients.
58 cases of mixed OAs and GBMOs were retrieved from the pathology archives of Seoul National University Hospital from 2004 to 2015. Reclassification was performed according to genetic and immunohistochemical properties. Clinicopathological characteristics of each subgroup were evaluated. Overall survival was assessed and compared between subgroups.
We could reclassify all mixed OAs and GBMOs into either astrocytic or oligodendroglial tumors. Notably, 29 GBMOs could be reclassified into 11 cases of glioblastoma (GBM), IDH-mutant, 16 cases of GBM, IDH-wildtype, and two cases of anaplastic oligodendroglioma, IDH mutant. Overall survival was significantly different among these new groups (p=0.000). Overall survival and progression-free survival were statistically better in gliomas with IDH mutation, ATRX mutation, no microscopic necrosis, and young patient age (cut off, 45 years old).
Our results strongly suggest that a genetically integrated diagnosis of glioma better reflects prognosis than former morphology-based methods.
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