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Jiang H, Zhu Q, Wang X, Li M, Shen S, Yang C, Zhao X, Li M, Ma G, Zhao X, Chen X, Yang J, Lin S. Characterization and clinical implications of different malignant transformation patterns in diffuse low-grade gliomas. Cancer Sci 2023; 114:3708-3718. [PMID: 37332121 PMCID: PMC10475770 DOI: 10.1111/cas.15889] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/08/2023] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Malignant transformation (MT) of low-grade gliomas (LGGs) to a higher-grade variant seems inevitable, yet it remains unclear which LGG patients will progress to grade 3 or even directly to grade 4 after receiving a long course of treatment. To elucidate this, we conducted a retrospective cohort study based on 229 adults with recurrent LGG. Our study aimed to disclose the characteristics of different MT patterns and to build predictive models for patients with LGG. Patients were allocated into group 2-2 (n = 81, 35.4%), group 2-3 (n = 91, 39.7%), and group 2-4 (n = 57, 24.9%), based on their MT patterns. Patients who underwent MT showed lower Karnofsky performance scale (KPS) scores, larger tumor sizes, smaller extents of resection (EOR), higher Ki-67 indices, lower rates of 1p/19q codeletion, but higher rates of subventricular involvement, radiotherapy, chemotherapy, astrocytoma, and post-progression enhancement (PPE) compared with those in group 2-2 (p < 0.01). On multivariate logistic regression, 1p/19q codeletion, Ki-67 index, radiotherapy, EOR, and KPS score were independently associated with MT (p < 0.05). Survival analyses demonstrated that patients in group 2-2 had the longest survival, followed by group 2-3 and then group 2-4 (p < 0.0001). Based on these independent parameters, we constructed a nomogram model that exhibited superior potential (sensitivity: 0.864, specificity: 0.814, and accuracy: 0.843) compared with PPE in early prediction of MT. Combining the factors of 1p/19q codeletion, Ki-67 index, radiotherapy, EOR, and KPS score that were presented at initial diagnosis could precisely forecast the subsequent MT patterns of patients with LGG.
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Affiliation(s)
- Haihui Jiang
- Department of NeurosurgeryPeking University Third Hospital, Peking UniversityBeijingChina
| | - Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xijie Wang
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Shaoping Shen
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Chuanwei Yang
- Department of Neurosurgery, Henan Provincial People's HospitalPeople's Hospital of Zhengzhou University, Zhengzhou UniversityZhengzhouChina
| | - Xuzhe Zhao
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Ming Li
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Guofo Ma
- Department of NeurosurgeryPeking University Third Hospital, Peking UniversityBeijingChina
| | - Xiaofang Zhao
- Department of NeurosurgeryPeking University Third Hospital, Peking UniversityBeijingChina
| | - Xiaodong Chen
- Department of NeurosurgeryPeking University Third Hospital, Peking UniversityBeijingChina
| | - Jun Yang
- Department of NeurosurgeryPeking University Third Hospital, Peking UniversityBeijingChina
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Neurological Diseases, Center of Brain TumorBeijing Institute for Brain Disorders and Beijing Key Laboratory of Brain TumorBeijingChina
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Nakasu S, Deguchi S, Nakasu Y. IDH wild-type lower-grade gliomas with glioblastoma molecular features: a systematic review and meta-analysis. Brain Tumor Pathol 2023:10.1007/s10014-023-00463-8. [PMID: 37212969 DOI: 10.1007/s10014-023-00463-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
The WHO 2021 classification defines IDH wild type (IDHw) histologically lower-grade glioma (hLGG) as molecular glioblastoma (mGBM) if TERT promoter mutation (pTERTm), EGFR amplification or chromosome seven gain and ten loss aberrations are indicated. We systematically reviewed articles of IDHw hLGGs studies (49 studies, N = 3748) and meta-analyzed mGBM prevalence and overall survival (OS) according to the PRISMA statement. mGBM rates in IDHw hLGG were significantly lower in Asian regions (43.7%, 95% confidence interval [CI: 35.8-52.0]) when compared to non-Asian regions (65.0%, [CI: 52.9-75.4]) (P = 0.005) and were significantly lower in fresh-frozen specimen when compared to formalin-fixed paraffin-embedded samples (P = 0.015). IDHw hLGGs without pTERTm rarely expressed other molecular markers in Asian studies when compared to non-Asian studies. Patients with mGBM had significantly longer OS times when compared to histological GBM (hGBM) (pooled hazard ratio (pHR) 0.824, [CI: 0.694-0.98], P = 0.03)). In patients with mGBM, histological grade was a significant prognostic factor (pHR 1.633, [CI: 1.09-2.447], P = 0.018), as was age (P = 0.001) and surgical extent (P = 0.018). Although bias risk across studies was moderate, mGBM with grade II histology showed better OS rates when compared to hGBM.
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Affiliation(s)
- Satoshi Nakasu
- Division of Neurosurgery, Omi Medical Center, Yabase-cho 1660, Kusatsu, Shiga, 525-8585, Japan.
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan.
| | - Shoichi Deguchi
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Yoko Nakasu
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
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Kreatsoulas D, Damante M, Gruber M, Duru O, Elder JB. Supratotal Surgical Resection for Low-Grade Glioma: A Systematic Review. Cancers (Basel) 2023; 15:cancers15092493. [PMID: 37173957 PMCID: PMC10177219 DOI: 10.3390/cancers15092493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Low-grade gliomas (LGGs) are optimally treated with up-front maximal safe surgical resection, typically defined as maximizing the extent of tumor resection while minimizing neurologic risks of surgery. Supratotal resection of LGG may improve outcomes beyond gross total resection by removing tumor cells invading beyond the tumor border as defined on MRI. However, the evidence regarding supratotal resection of LGG, in terms of impact on clinical outcomes, such as overall survival and neurologic morbidities, remains unclear. Authors independently searched the PubMed, Medline, Ovid, CENTRAL (Cochrane Central Register of Controlled Trials), and Google Scholar databases for studies evaluating overall survival, time to progression, seizure outcomes, and postoperative neurologic and medical complications of supratotal resection/FLAIRectomy of WHO-defined LGGs. Papers in languages other than English, lacking full-text availability, evaluating supratotal resection of WHO-defined high-grade gliomas only, and nonhuman studies were excluded. After literature search, reference screening, and initial exclusions, 65 studies were screened for relevancy, of which 23 were evaluated via full-text review, and 10 were ultimately included in the final evidence review. Studies were evaluated for quality using the MINORS criteria. After data extraction, a total of 1301 LGG patients were included in the analysis, with 377 (29.0%) undergoing supratotal resection. The main measured outcomes were extent of resection, pre- and postoperative neurological deficits, seizure control, adjuvant treatment, neuropsychological outcomes, ability to return to work, progression-free survival, and overall survival. Overall, low- to moderate-quality evidence was supportive of aggressive, functional boundary-based resection of LGGs due to improvements in progression-free survival and seizure control. The published literature provides a moderate amount of low-quality evidence supporting supratotal surgical resection along functional boundaries for low-grade glioma. Among patients included in this analysis, the occurrence of postoperative neurological deficits was low, and nearly all patients recovered within 3 to 6 months after surgery. Notably, the surgical centers represented in this analysis have significant experience in glioma surgery in general, and supratotal resection specifically. In this setting, supratotal surgical resection along functional boundaries appears to be appropriate for both symptomatic and asymptomatic low-grade glioma patients. Larger clinical studies are needed to better define the role of supratotal resection in LGG.
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Affiliation(s)
- Daniel Kreatsoulas
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Mark Damante
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Maxwell Gruber
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Olivia Duru
- College of Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - James Bradley Elder
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
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Lee K, Kim SI, Kim EE, Shim YM, Won JK, Park CK, Choi SH, Yun H, Lee H, Park SH. Genomic profiles of IDH-mutant gliomas: MYCN-amplified IDH-mutant astrocytoma had the worst prognosis. Sci Rep 2023; 13:6761. [PMID: 37185778 PMCID: PMC10130138 DOI: 10.1038/s41598-023-32153-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/23/2023] [Indexed: 05/17/2023] Open
Abstract
This study aimed to find any ambiguous genetic outlier for "oligodendroglioma, IDH-mutant and 1p/19q-codeleted (O_IDH_mut)" and "astrocytoma, IDH-mutant (A_IDH_mut)" and to redefine the genetic landscape and prognostic factors of IDH-mutant gliomas. Next-generation sequencing (NGS) using a brain tumor-targeted gene panel, methylation profiles, and clinicopathological features were analyzed for O_IDH_mut (n = 74) in 70 patients and for A_IDH_mut (n = 95) in 90 patients. 97.3% of O_IDH_mut and 98.9% of A_IDH_mut displayed a classic genomic landscape. Combined CIC (75.7%) and/or FUBP1 (45.9%) mutations were detected in 93.2% and MGMTp methylation in 95.9% of O_IDH_mut patients. In A_IDH_mut, TP53 mutations were found in 86.3% and combined ATRX (82.1%) and TERTp (6.3%) mutations in 88.4%. Although there were 3 confusing cases, NOS (not otherwise specified) category, based on genetic profiles, but they were clearly classified by combining histopathology and DKFZ methylation classifier algorithms. The patients with MYCN amplification and/or CDKN2A/2B homozygous deletion in the A_IDH_mut category had a worse prognosis than those without these gene alterations and MYCN-amplified A_IDH_mut showed the worst prognosis. However, there was no prognostic genetic marker in O_IDH_mut. In histopathologically or genetically ambiguous cases, methylation profiles can be used as an objective tool to avoid a diagnosis of NOS or NEC (not elsewhere classified), as well as for tumor classification. The authors have not encountered a case of true mixed oligoastrocytoma using an integrated diagnosis of histopathological, genetic and methylation profiles. MYCN amplification, in addition to CDKN2A/2B homozygous deletion, should be included in the genetic criteria for CNS WHO grade 4 A_IDH_mut.
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Affiliation(s)
- Kwanghoon Lee
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong-Ik Kim
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eric Eunshik Kim
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yu-Mi Shim
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Kyung Won
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chul-Kee Park
- Department of Neurosurgery, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung Hong Choi
- Department of Radiology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hongseok Yun
- Department of Genomic Medicine, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunju Lee
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, Gwangju, 61005, Republic of Korea
- Artificial Intelligence Graduate School, Gwangju Institute of Science and Technology, Gwangju, 61005, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Nakasu S, Nakasu Y, Tsuji A, Fukami T, Nitta N, Kawano H, Notsu A, Nozaki K. Incidental diffuse low-grade gliomas: A systematic review and meta-analysis of treatment results with correction of lead-time and length-time biases. Neurooncol Pract 2023; 10:113-125. [PMID: 36970177 PMCID: PMC10037942 DOI: 10.1093/nop/npac073] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Better overall survival (OS) reported in patients with incidental diffuse low-grade glioma (iLGG) in comparison to symptomatic LGG (sLGG) may be overestimated by lead-time and length-time. Methods We performed a systematic review and meta-analysis of studies on adult hemispheric iLGGs according to the PRISMA statement to adjust for biases in their outcomes. Survival data were extracted from Kaplan-Meier curves. Lead-time was estimated by 2 methods: Pooled data of time to become symptomatic (LTs) and time calculated from the tumor growth model (LTg). Results We selected articles from PubMed, Ovid Medline, and Scopus since 2000. Five compared OS between patients with iLGG (n = 287) and sLGG (n = 3117). The pooled hazard ratio (pHR) for OS of iLGG to sLGG was 0.40 (95% confidence interval [CI] {0.27-0.61}). The estimated mean LTs and LTg were 3.76 years (n = 50) and 4.16-6.12 years, respectively. The corrected pHRs were 0.64 (95% CI [0.51-0.81]) by LTs and 0.70 (95% CI [0.56-0.88]) by LTg. In patients with total removal, the advantage of OS in iLGG was lost after the correction of lead-time. Patients with iLGG were more likely to be female pooled odds ratio (pOR) 1.60 (95% CI [1.25-2.04]) and have oligodendrogliomas (pOR 1.59 [95% CI {1.05-2.39}]). Correction of the length-time bias, which increased the pHR by 0.01 to 0.03, preserved the statistically significant difference in OS. Conclusions The reported outcome in iLGG was biased by lead-time and length-time. Although iLGG had a longer OS after correction of biases, the difference was less than previously reported.
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Affiliation(s)
- Satoshi Nakasu
- Division of Neurosurgery, Omi Medical Center, Kusatsu, Japan
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Yoko Nakasu
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
- Division of Neurosurgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Atsushi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Tadateru Fukami
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Naoki Nitta
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Hiroto Kawano
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
| | - Akifumi Notsu
- Clinical Research Center, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Ohtsu, Japan
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Liu K, Liao X, Chen Y, Jiang S. Adjuvant Chemoradiation Therapy Versus Chemotherapy Alone for Resected Oligodendroglioma: A Surveillance, Epidemiology and End Results (SEER) Analysis. World Neurosurg 2023; 170:e37-e44. [PMID: 36273731 DOI: 10.1016/j.wneu.2022.10.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/17/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The benefit of postoperative adjuvant therapy for survival of oligodendrocyte glioma remains unclear. In this study, we compared the effect of chemoradiation therapy (CRT) and chemotherapy (CT) alone in patients who underwent resection. We aim to identify which adjuvant therapy provides more survival benefits. METHODS We identified patients who underwent oligodendroglioma resection in the Surveillance, Epidemiology and End Results (SEER) database. A multivariate Cox regression analysis was used to evaluate the factors affecting survival rates. We used a propensity matching analysis to minimize selection bias in each group. We performed subgroup analyses based on patients' clinical characteristics. RESULTS This study identified 1826 patients who received adjuvant CT (n = 503) or adjuvant CRT (n = 1323). On multivariate analysis, elderly, white and other race, and temporal lobe and parietal lobe tumor site were independent risk factors for improved overall survival (OS). After 1:1 propensity match, we included 501 patients who received CT and 501 with CRT. Patients in the CT group showed improved overall survival rate compared with those who received CRT (median OS: 146 months vs. 111 months). Subgroup analysis showed that improved overall survival in CT group was more significant in patients who were younger or older, male or female, white race, frontal lobe and parietal lobe tumor site, smaller tumor size (≤4 cm), and with gross total resection (GTR) (P < 0.05). CONCLUSIONS In patients with resected oligodendroglioma, adjuvant CT is associated with better survival compared to adjuvant CRT. The benefit was more significant in patients who were younger and older, male and female, white race, frontal lobe and parietal lobe tumor site, smaller tumor size (≤4 cm), and with GTR.
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Affiliation(s)
- Kepeng Liu
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China
| | - Xiaozu Liao
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China
| | - Yong Chen
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China
| | - Shengjie Jiang
- Department of Anesthesiology, Zhongshan Hospital of Sun Yat-Sen University (Zhongshan City People's Hospital), Zhongshan, Guangdong, China.
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Liu V, Wetzel EA, Eldred BSC, Zapanta Rinonos S, Prins TJ, Khanlou N, Liau LM, Chong R, Nghiemphu PL, Cloughesy TF, Ellingson BM, Lai A. A single-institution retrospective analysis of pathologically determined malignant transformation in IDH mutant glioma patients. Neurooncol Adv 2023; 5:vdad036. [PMID: 37152809 PMCID: PMC10162112 DOI: 10.1093/noajnl/vdad036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
Background Lower-grade IDH mutant glioma patients frequently undergo malignant transformation (MT), with apparent worse prognosis. Many studies examine MT in mixed IDH status cohorts and define MT using imaging, not histopathology. Our study examines the timing, predictors, and prognostic implications of pathologically determined MT in a large, exclusively IDH mutant cohort. Methods We identified 193 IDH mutant lower-grade glioma patients at UCLA who received multiple surgeries. We examined the outcomes of pathologically determined MT patients. Results Time to MT is longer in grade 2 oligodendroglioma (G2 Oligo) than in grade 2 astrocytoma (G2 Astro) (HR = 0.46, P = .0007). The grade 3 astrocytoma (G3 Astro) to grade 4 astrocytoma (G4 Astro) interval is shorter in stepwise MT (G2 to G3 to G4 Astro) patients than in initial G3 Astro patients (P = .03). Novel contrast enhancement had 65% positive predictivity, 67% negative predictivity, 75% sensitivity, and 55% specificity in indicating pathologically defined MT. In G2 Astro, initial gross total resection delayed MT (HR = 0.50, P = .02) and predicted better overall survival (OS) (HR = 0.34, P = .009). In G2 Oligo, spontaneous MT occurred earlier than treated MT (HR = 11.43, P = .0002), but treatment did not predict improved OS (P = .8). MT patients (n = 126) exhibited worse OS than non-MT patients (n = 67) in All (HR = 2.54, P = .0009) and G2 Astro (HR = 4.26, P = .02). Conclusion Our study expands the understanding of MT to improve IDH mutant lower-grade glioma management.
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Affiliation(s)
- Vicki Liu
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Ethan A Wetzel
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Blaine S C Eldred
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Serendipity Zapanta Rinonos
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Terry J Prins
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Linda M Liau
- Department of Neurosurgery, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Robert Chong
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Phioanh L Nghiemphu
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Benjamin M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
| | - Albert Lai
- Department of Neurology, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California, USA
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