Clinical value of molecular pathology in glioma

Objective To summarize the clinical value of molecular pathology in glioma. Methods and Results The clinical course and molecular pathology results of 3 glioma patients were compared. All 3 patients underwent integrated diagnosis according to the WHO 2016 diagnostic criteria. Molecular pathology included whole exome sequencing (WES) and detection of MGMT promoter methylation and TERT promoter mutation. Case 1 had the first surgery 32 years ago, diagnosed with left frontal glioma, only radiotherapy after surgery. The tumor was found recurrent 31 years later. Molecular pathology after reoperation suggested IDH mutation, 1p/19q combined deletion, TERT promoter region mutation, MGMT promoter methylation positive, integration diagnosed as anaplastic oligodendroglioma. The patient had overall survival over 32 years, and was still alive. Case 2 underwent two surgeries within 6 months, molecular pathology suggested IDH wild type, 1p/19q without combined deletion, TERT promoter region mutation, MGMT promoter non⁃methylation, integration diagnosed as glioblastoma. The overall survival was 6 months. Case 3 was suffered from left temporal giant glioma. Molecular pathology after total tumor removal revealed IDH wild type, 1p/19q without combined deletion, and non⁃mutation in the TERT promoter region, and MGMT promoter non⁃methylation. The integration diagnosis was glioblastoma. This patient underwent concurrent chemoradiotherapy after surgery. MRI showed signs of recurrence after 2 months. According to the results of WES, this patient had FGFR3 amplification, and Anrotinib the multi⁃target tyrosinase inhibitor was used, which was gradually relieved after 2 months. Conclusions The molecular pathology of glioma patients can help clinicians to integrate diagnosis, predict the prognosis, and help neurosurgeons to screen drugs. DOI：10.3969/j.issn.1672⁃6731.2019.11.010