Table 1
Clinical characteristics of 60 patients with diffuse gliomas
| Characteristics | No. of Patients (%) |
|---|---|
| Number of patients | 60 (100) |
| Sex | |
| Male | 35 (58.3) |
| Female | 25 (41.7) |
| Age (yrs) | |
| Average ± SD | 60.7 ± 15.4 |
| Median | 62.5 |
| Range | 6 - 80 |
| Tumor grades and subtypes (WHO 2007) | |
| Grade II | 8 (13.3) |
| Astrocytoma | 2 (3.3) |
| Oligoastrocytoma | 3 (5.0) |
| Oligodendroglioma | 3 (5.0) |
| Grade III | 17 (28.3) |
| Anaplastic astrocytoma | 2 (3.3) |
| Anaplastic oligoastrocytoma | 3 (5.0) |
| Anaplastic oligodendroglioma | 12 (20.0) |
| Grade IV | 35 (58.3) |
| Localization | |
| Frontal | 22 (36.7) |
| Fronto-temporal | 2 (3.3) |
| Temporal | 9 (15.0) |
| Temporo-parietal | 5 (8.3) |
| Temporal & insular | 2 (3.3) |
| Parietal | 4 (6.7) |
| Parieto-occipital | 2 (3.3) |
| Occipital | 0 (0) |
| Insular | 4 (6.7) |
| Central | 8 (13.3) |
| Cerebellar | 2 (3.3) |
| Tumor Status | |
| Primary | 54 (90.0) |
| Recurrence | 6 (10.0) |
Comparison of tumor characteristics on MRI scans. Axial T2W images showing a mass with (A) a smooth and (B) an indistinct tumor border in the left frontal lobe, (C) homogeneous intensity in the right frontal lobe, and (D) heterogeneous intensity in the left thalamus. Axial gadolinium-enhanced T1W images show that (E) the tumor lacks contrast enhancement in the right frontal lobe and is (F) contrast-enhanced in the left parietal lobe.
Appearance of the tumor cavity under the surgical microscope. (A-B) Violet-blue light excitation yielding visible 5-ALA fluorescence. Note robust (lava-like orange) (A) and mild (pink) brightness (B). (C) No 5-ALA fluorescence is visualized in the tumor cavity.
Table 2
5-aminolevulinic acid-induced fluorescence (5-ALA) in 60 diffuse gliomas
| 5-ALA fluorescence | WHO grade II | WHO grade III | WHO grade IV |
|---|---|---|---|
| Positive | 2/8 (25 %) | 9/17 (53 %) | 31/35 (89%) |
| Negative | 6/8 (75 %) | 8/17 (47 %) | 4/35 (11%) |
Table 3
Relationsh ip between 5-aminolevulinic acid-induced fluorescence (5-ALA) status and clinical-pathologic features
| Clinical-pathologic features | Patients with visible fluorescence (n=42) | Patients with no visible fluorescence (n=18) | P value | χ2, Fisher, or Student t test |
|---|---|---|---|---|
| Age (years) | ||||
| Average ± SD | 62.4 ± 16.4 | 56.7 ± 12.5 | 0.16 | - |
| IDH1 mutation | <0.001 | 23.57 | ||
| Positive | 2 | 11 | ||
| Negative | 40 | 7 | ||
| 1p19q LOH | 0.003 | 10.22 | ||
| Positive | 5 | 9 | ||
| Negative | 37 | 9 | ||
| MGMT methylation | 0.05 | 4.35 | ||
| Positive | 18 | 13 | ||
| Negative | 24 | 5 | ||
| MIB1 LI (%) | ||||
| Average ± SD | 38.5 ± 20.7 | 20.2 ± 22.8 | 0.007 | - |
| Tumor margin | 0.046 | 4.88 | ||
| Irregular | 27 | 6 | ||
| Smooth | 15 | 12 | ||
| T2 Heterogeneity | 0.021 | 6.48 | ||
| Homo | 2 | 5 | ||
| Hetero | 40 | 13 | ||
| Contrast enhancement | 0.002 | 11.71 | ||
| Positive | 41 | 12 | ||
| Negative | 1 | 6 |
Table 4
Multivariate analysis of significant factors from univariate analysis
| Factor | P Value | Odds ratio | 95% confidence interval |
|---|---|---|---|
| IDH1 wild type | 0.009 | 19.238 | 1.39, 175.39 |
| 1p19q LOH | 0.198 | 0.301 | 0.05, 1.87 |
| MIB-1 labeling index | 0.157 | 1.033 | 0.99, 1.08 |
| Tumor margin | 0.743 | 0.720 | 0.10, 5.15 |
| T2 heterogeneity | 0.470 | 2.763 | 0.18, 43.44 |
| Contrast enhancement | 0.345 | 4.107 | 0.22, 77.32 |
Schematic illustration of the relationship between heme synthesis and the IDH1 mutation. Thick arrows indicate metabolism activation, white arrows the activated enzymes or plasma membrane structures involved in porphyrin metabolism. ABCG2 transports porphyrins from the cytoplasm to the extracellular space. NADP+ levels increase during metabolization to bilirubin by heme. The IDH1 mutation may promote a defense system against ROS by activating catalase, HO-1, etc. The intracellular PPIX level is downregulated. (ABCG2 = ATP-binding cassette transporter G2; CO = carbon monoxide; FECH = ferrochelatase; HO-1 = heme oxygenase-1; PP = protoporphyrin; ROS = reactive oxygen species).