Clinical updates on gliomas and implications of the 5th edition of the WHO classification of central nervous system tumors

Xiaopeng Guo; Yixin Shi; Delin Liu; Yilin Li; Wenlin Chen; Yaning Wang; Yuekun Wang; Hao Xing; Yu Xia; Junlin Li; Jiaming Wu; Tingyu Liang; Hai Wang; Qianshu Liu; Shanmu Jin; Tian Qu; Siying Guo; Huanzhang Li; Tianrui Yang; Kun Zhang; Yu Wang; Wenbin Ma

doi:10.3389/fonc.2023.1131642

Clinical updates on gliomas and implications of the 5th edition of the WHO classification of central nervous system tumors

Front Oncol. 2023 Mar 14:13:1131642. doi: 10.3389/fonc.2023.1131642. eCollection 2023.

Authors

Xiaopeng Guo^{1

2}, Yixin Shi^{1

3}, Delin Liu^{1

3}, Yilin Li^{1

4}, Wenlin Chen¹, Yaning Wang¹, Yuekun Wang¹, Hao Xing¹, Yu Xia^{1

3}, Junlin Li^{1

3}, Jiaming Wu^{1

3}, Tingyu Liang¹, Hai Wang¹, Qianshu Liu^{1

3}, Shanmu Jin^{1

4}, Tian Qu^{1

3}, Siying Guo^{1

3}, Huanzhang Li^{1

3}, Tianrui Yang^{1

3}, Kun Zhang^{1

3}, Yu Wang^{1

2}, Wenbin Ma^{1

2}

Affiliations

¹ Department of Neurosurgery, Center for Malignant Brain Tumors, National Glioma MDT Alliance, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² China Anti-Cancer Association Specialty Committee of Glioma, Beijing, China.
³ Eight-year Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ '4+4' Medical Doctor Program, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: The 5th edition of the World Health Organization (WHO) classification of central nervous system tumors incorporated specific molecular alterations into the categorization of gliomas. The major revision of the classification scheme effectuates significant changes in the diagnosis and management of glioma. This study aimed to depict the clinical, molecular, and prognostic characteristics of glioma and its subtypes according to the current WHO classification.

Methods: Patients who underwent surgery for glioma at Peking Union Medical College Hospital during 11 years were re-examined for tumor genetic alterations using next-generation sequencing, polymerase chain reaction-based assay, and fluorescence in situ hybridization methods and enrolled in the analysis.

Results: The enrolled 452 gliomas were reclassified into adult-type diffuse glioma (ntotal=373; astrocytoma, n=78; oligodendroglioma, n=104; glioblastoma, n=191), pediatric-type diffuse glioma (ntotal=23; low-grade, n=8; high-grade, n=15), circumscribed astrocytic glioma (n=20), and glioneuronal and neuronal tumor (n=36). The composition, definition, and incidence of adult- and pediatric-type gliomas changed significantly between the 4th and the 5th editions of the classification. The clinical, radiological, molecular, and survival characteristics of each subtype of glioma were identified. Alterations in CDK4/6, CIC, FGFR2/3/4, FUBP1, KIT, MET, NF1, PEG3, RB1, and NTRK2 were additional factors correlated with the survival of different subtypes of gliomas.

Conclusions: The updated WHO classification based on histology and molecular alterations has updated our understanding of the clinical, radiological, molecular, survival, and prognostic characteristics of varied subtypes of gliomas and provided accurate guidance for diagnosis and potential prognosis for patients.

Keywords: WHO classification of central nervous system tumors; glioblastoma; glioma; integrated diagnosis; molecular alteration.

Grants and funding

This study was supported by Beijing Municipal Natural Science Foundation (7202150) and the National High Level Hospital Clinical Research Funding (2022-PUMCH-A-019) for YW, Tsinghua University-Peking Union Medical College Hospital Initiative Scientific Research Program (2019ZLH101), and Beijing Municipal Natural Science Foundation (19JCZDJC64200[Z]) for WM.