Imaging-Based Versus Pathologic Survival Stratifications of Diffuse Glioma According to the 2021 WHO Classification...

Area of Science:

• Neuro-oncology
• Radiology
• Pathology

Background:

• Accurate survival stratification of diffuse glioma patients is crucial for effective management.
• The 2021 World Health Organization (WHO) classification requires clinical validation for its imaging-based survival stratification methods.

Purpose of the Study:

• To compare the efficacy of integrative imaging- and pathology-based methods for survival stratification in diffuse glioma patients.
• To evaluate the performance of the 2021 WHO classification's imaging-based risk stratification.

Main Methods:

• Analysis of diffuse glioma cases from The Cancer Genome Atlas (141 patients) and Asan Medical Center (131 patients).
• Neuroradiologists assigned gliomas to five imaging-based risk subgroups and three risk groups based on the 2021 WHO classification using CT and MRI.
• Progression-free survival (PFS) and overall survival (OS) were estimated and compared using time-dependent area under the receiver operating characteristic (AUC) analysis.

Main Results:

• Both OS and PFS were significantly stratified by imaging-based risk subgroups and groups (P < 0.001).
• The imaging-based groups showed high performance in predicting 1-year (AUC, 0.787) and 5-year PFS (AUC, 0.823), comparable to pathology-based predictions.
• Combined with clinical predictors, imaging-based models achieved similar performance to pathology-based models for 1- and 3-year PFS.

Conclusions:

• Imaging-based survival stratification using the 2021 WHO classification demonstrates performance similar to pathology-based methods.
• This imaging approach is particularly effective for predicting progression-free survival in diffuse gliomas.
• The findings support the clinical utility of the 2021 WHO classification for glioma management.