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Abstract：
OBJECTIVE: The study aimed to identify if clinical features and survival outcomes of insular glioma patients are associated with our classification based on the tumor spread.
METHODS: Our study included 283 consecutive patients diagnosed with histological grade 2 and 3 insular gliomas. A new classification was proposed, and tumors restricted to the paralimbic system were defined as type 1. When tumors invaded the limbic system (referred to as the hippocampus and its surrounding structures in this study) simultaneously, they were defined as type 2. Tumors with additional internal capsule involvement were defined as type 3.
RESULTS: Tumors defined as type 3 had a higher age at diagnosis (p = 0.002) and a higher preoperative volume (p < 0.001). Furthermore, type 3 was more likely to be diagnosed as IDH wild type (p < 0.001), with a higher rate of Ki-67 index (p = 0.015) and a lower rate of gross total resection (p < 0.001). Type 1 had a slower tumor growth rate than type 2 (mean 3.3%/month vs. 19.8%/month; p < 0.001). Multivariate Cox regression analysis revealed the extent of resection (HR 0.259, p = 0.004), IDH status (HR 3.694, p = 0.012), and tumor spread type (HR = 1.874, p = 0.012) as independent predictors of overall survival (OS). Tumor grade (HR 2.609, p = 0.008), the extent of resection (HR 0.488, p = 0.038), IDH status (HR 2.225, p = 0.025), and tumor spread type (HR 1.531, p = 0.038) were significant in predicting progression-free survival (PFS).
CONCLUSIONS: The current study proposes a classification of the insular glioma according to the tumor spread. It indicates that the tumors defined as type 1 have a relatively better nature and biological characteristics, and those defined as type 3 can be more aggressive and refractory. Besides its predictive value for prognosis, the classification has potential value in formulating surgical strategies for patients with insular gliomas.
METHODS: Our study included 283 consecutive patients diagnosed with histological grade 2 and 3 insular gliomas. A new classification was proposed, and tumors restricted to the paralimbic system were defined as type 1. When tumors invaded the limbic system (referred to as the hippocampus and its surrounding structures in this study) simultaneously, they were defined as type 2. Tumors with additional internal capsule involvement were defined as type 3.
RESULTS: Tumors defined as type 3 had a higher age at diagnosis (p = 0.002) and a higher preoperative volume (p < 0.001). Furthermore, type 3 was more likely to be diagnosed as IDH wild type (p < 0.001), with a higher rate of Ki-67 index (p = 0.015) and a lower rate of gross total resection (p < 0.001). Type 1 had a slower tumor growth rate than type 2 (mean 3.3%/month vs. 19.8%/month; p < 0.001). Multivariate Cox regression analysis revealed the extent of resection (HR 0.259, p = 0.004), IDH status (HR 3.694, p = 0.012), and tumor spread type (HR = 1.874, p = 0.012) as independent predictors of overall survival (OS). Tumor grade (HR 2.609, p = 0.008), the extent of resection (HR 0.488, p = 0.038), IDH status (HR 2.225, p = 0.025), and tumor spread type (HR 1.531, p = 0.038) were significant in predicting progression-free survival (PFS).
CONCLUSIONS: The current study proposes a classification of the insular glioma according to the tumor spread. It indicates that the tumors defined as type 1 have a relatively better nature and biological characteristics, and those defined as type 3 can be more aggressive and refractory. Besides its predictive value for prognosis, the classification has potential value in formulating surgical strategies for patients with insular gliomas.
摘要：
目的：该研究旨在确定岛叶胶质瘤患者的临床特征和生存结果是否与我们基于肿瘤扩散的分类相关。
方法：我们的研究包括283例诊断为组织学2级和3级岛叶胶质瘤的连续患者。提出了一种新的分类，和局限于旁联系统的肿瘤被定义为1型。当肿瘤同时侵入边缘系统（在本研究中称为海马及其周围结构）时，它们被定义为类型2。具有其他内囊受累的肿瘤被定义为3型。
结果：定义为3型的肿瘤在诊断时具有较高的年龄（p=0.002）和较高的术前体积（p<0.001）。此外，3型更有可能被诊断为IDH野生型（p<0.001），具有较高的Ki-67指数（p=0.015）和较低的总切除率（p<0.001）。1型的肿瘤生长速度比2型慢（平均3.3%/月vs.19.8%/月；p<0.001）。多因素Cox回归分析显示切除程度（HR0.259，p=0.004），IDH状态（HR3.694，p=0.012），和肿瘤扩散类型（HR=1.874，p=0.012）是总生存期（OS）的独立预测因子。肿瘤分级（HR2.609，p=0.008），切除范围（HR0.488，p=0.038），IDH状态（HR2.225，p=0.025），和肿瘤扩散类型（HR1.531，p=0.038）在预测无进展生存期（PFS）方面具有重要意义。
结论：目前的研究提出了根据肿瘤扩散对岛叶胶质瘤进行分类的方法。这表明定义为1型的肿瘤具有相对较好的性质和生物学特性，被定义为3型的那些可能更具侵略性和难治性。除了对预后的预测价值外，该分类对制定岛叶胶质瘤患者的手术策略具有潜在价值。
方法：我们的研究包括283例诊断为组织学2级和3级岛叶胶质瘤的连续患者。提出了一种新的分类，和局限于旁联系统的肿瘤被定义为1型。当肿瘤同时侵入边缘系统（在本研究中称为海马及其周围结构）时，它们被定义为类型2。具有其他内囊受累的肿瘤被定义为3型。
结果：定义为3型的肿瘤在诊断时具有较高的年龄（p=0.002）和较高的术前体积（p<0.001）。此外，3型更有可能被诊断为IDH野生型（p<0.001），具有较高的Ki-67指数（p=0.015）和较低的总切除率（p<0.001）。1型的肿瘤生长速度比2型慢（平均3.3%/月vs.19.8%/月；p<0.001）。多因素Cox回归分析显示切除程度（HR0.259，p=0.004），IDH状态（HR3.694，p=0.012），和肿瘤扩散类型（HR=1.874，p=0.012）是总生存期（OS）的独立预测因子。肿瘤分级（HR2.609，p=0.008），切除范围（HR0.488，p=0.038），IDH状态（HR2.225，p=0.025），和肿瘤扩散类型（HR1.531，p=0.038）在预测无进展生存期（PFS）方面具有重要意义。
结论：目前的研究提出了根据肿瘤扩散对岛叶胶质瘤进行分类的方法。这表明定义为1型的肿瘤具有相对较好的性质和生物学特性，被定义为3型的那些可能更具侵略性和难治性。除了对预后的预测价值外，该分类对制定岛叶胶质瘤患者的手术策略具有潜在价值。
