TERT mutations-associated alterations in clinical characteristics, immune environment and therapy response in glioblastomas

MRI transformer deep learning and radiomics for predicting IDH wild type TERT promoter mutant gliomas

This study aims to predict IDH wt with TERTp-mut gliomas using multiparametric MRI sequences through a novel fusion model, while matching model classification metrics with patient risk stratification aids in crafting personalized diagnostic and prognosis evaluations.Preoperative T1CE and T2FLAIR sequences from 1185 glioma patients were analyzed. A MultiChannel_2.5D_DL model and a 2D DL model, both based on the cross-scale attention vision transformer (CrossFormer) neural network, along with a Radiomics model, were developed. These were integrated via ensemble learning into a stacking model. The MultiChannel_2.5D_DL model outperformed the 2D_DL and Radiomics models, with AUCs of 0.806-0.870. The stacking model achieved the highest AUC (0.855-0.904) across validation sets. Patients were stratified into high-risk and low-risk groups based on stacking model scores, with significant survival differences observed via Kaplan-Meier analysis and log-rank tests. The stacking model effectively identifies IDH wt TERTp-mutant gliomas and stratifies patient risk, aiding personalized prognosis.

Research Progress on Glioma Microenvironment and Invasiveness Utilizing Advanced Multi-Parametric Quantitative MRI

Magnetic resonance imaging (MRI) currently serves as the primary diagnostic method for glioma detection and monitoring. The integration of neurosurgery, radiation therapy, pathology, and radiology in a multi-disciplinary approach has significantly advanced its diagnosis and treatment. However, the prognosis remains unfavorable due to treatment resistance, inconsistent response rates, and high recurrence rates after surgery. These factors are closely associated with the complex molecular characteristics of the tumors, the internal heterogeneity, and the relevant external microenvironment. The complete removal of gliomas presents challenges due to their infiltrative growth pattern along the white matter fibers and perivascular space. Therefore, it is crucial to comprehensively understand the molecular features of gliomas and analyze the internal tumor heterogeneity in order to accurately characterize and quantify the tumor invasion range. The multi-parameter quantitative MRI technique provides an opportunity to investigate the microenvironment and aggressiveness of glioma tumors at the cellular, blood perfusion, and cerebrovascular response levels. Therefore, this review examines the current applications of advanced multi-parameter quantitative MRI in glioma research and explores the prospects for future development.

Cellular Components of the Tumor Environment in Gliomas-What Do We Know Today?

A generation ago, the molecular properties of tumor cells were the focus of scientific interest in oncology research. Since then, it has become increasingly apparent that the tumor environment (TEM), whose major components are non-neoplastic cell types, is also of utmost importance for our understanding of tumor growth, maintenance and resistance. In this review, we present the current knowledge concerning all cellular components within the TEM in gliomas, focusing on their molecular properties, expression patterns and influence on the biological behavior of gliomas. Insight into the TEM of gliomas has expanded considerably in recent years, including many aspects that previously received only marginal attention, such as the phenomenon of phagocytosis of glioma cells by macrophages and the role of the thyroid-stimulating hormone on glioma growth. We also discuss other topics such as the migration of lymphocytes into the tumor, phenotypic similarities between chemoresistant glioma cells and stem cells, and new clinical approaches with immunotherapies involving the cells of TEM.

Unexplained Causes of Glioma-Associated Epilepsies: A Review of Theories and an Area for Research

Approximately 30% of glioma patients are able to survive beyond one year postdiagnosis. And this short time is often overshadowed by glioma-associated epilepsy. This condition severely impairs the patient's quality of life and causes great suffering. The genetic, molecular and cellular mechanisms underlying tumour development and epileptogenesis remain incompletely understood, leading to numerous unanswered questions. The various types of gliomas, namely glioblastoma, astrocytoma and oligodendroglioma, demonstrate distinct seizure susceptibility and disease progression patterns. Patterns have been identified in the presence of IDH mutations and epilepsy, with tumour location in cortical regions, particularly the frontal lobe, showing a more frequent association with seizures. Altered expression of TP53, MGMT and VIM is frequently detected in tumour cells from individuals with epilepsy associated with glioma. However, understanding the pathogenesis of these modifications poses a challenge. Moreover, hypoxic effects induced by glioma and associated with the HIF-1a factor may have a significant impact on epileptogenesis, potentially resulting in epileptiform activity within neuronal networks. We additionally hypothesise about how the tumour may affect the functioning of neuronal ion channels and contribute to disruptions in the blood-brain barrier resulting in spontaneous depolarisations.