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Background and aim <p>High-grade gliomas (HGGs) are aggressive primary brain tumors with inevitable recurrence. This single-center retrospective study investigates whether the anatomical proximity of HGGs to major white matter tracts influences progression and recurrence. The study explores the association between tumor location and recurrence type—local, remote, or ependymal—and whether recurrences align with adjacent white matter tracts.</p> Methods <p>The study included patients with histopathologically confirmed recurrent HGGs who underwent reoperation. Primary tumors were categorized into four anatomical subgroups using a connectivity-based framework from the HCP 1065 Atlas: <b>Subgroup A</b>: Long Fronto-Temporo-Parietal Network <b>Subgroup B</b>: Temporal Pole Network (further divided into B1, B2, and B3 based on connectivity patterns) <b>Subgroup C</b>: Frontal Pole Network <b>Subgroup D</b>: Commissural and Projection Networks (further divided into D1 and D2). Recurrences were classified via post-contrast T1-weighted MRI as local, remote, ependymal. The Tract-to-Region Connectome (T-R-C) assessed the volumetric overlap between recurrence maps and main white matter bundles.</p> Results <p>Of 41 patients, a significant correlation emerged between tumor subgroup and recurrence type (<i>p</i> = 0.0003). Subgroup A predominantly showed remote recurrences (68%), while B2, B3, C, and D2 had mainly local recurrences. Subgroup D1 had a predominance of ependymal recurrences (66.7%). Local and remote recurrences largely conformed to adjacent white matter distributions, with variations in timing of recurrence and survival observed across different groups.</p> Conclusion <p>Our analysis, focused on exploring the spatial aspects of recurrence in relation to white matter anatomy, suggests that HGG recurrence patterns are strongly influenced by anatomical location and white matter architecture. Certain anatomical areas show a predisposition toward specific recurrence patterns. Recognizing these spatial dynamics may guide more precise surgical strategies, radiotherapy targeting, and recurrence risk assessment.</p>

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A white matter-centered approach to investigate recurrence pathways in high-grade gliomas: a single-center retrospective study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月3日

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  • Salvatore Marino,
  • Grazia Menna,
  • Francesco Doglietto,
  • Davide Quaranta,
  • Silvia Chiesa,
  • Simona Gaudino,
  • Rosellina Russo,
  • Gianmaria Marziali,
  • Marco Galeazzi,
  • Quintino Giorgio D’Alessandris,
  • Liverana Lauretti,
  • Pier Paolo Mattogno,
  • Rina Di Bonaventura,
  • Naike Caraglia,
  • Lucia Di Maio,
  • Alessandro Olivi,
  • Giuseppe Maria Della Pepa

摘要

Background and aim

High-grade gliomas (HGGs) are aggressive primary brain tumors with inevitable recurrence. This single-center retrospective study investigates whether the anatomical proximity of HGGs to major white matter tracts influences progression and recurrence. The study explores the association between tumor location and recurrence type—local, remote, or ependymal—and whether recurrences align with adjacent white matter tracts.

Methods

The study included patients with histopathologically confirmed recurrent HGGs who underwent reoperation. Primary tumors were categorized into four anatomical subgroups using a connectivity-based framework from the HCP 1065 Atlas: Subgroup A: Long Fronto-Temporo-Parietal Network Subgroup B: Temporal Pole Network (further divided into B1, B2, and B3 based on connectivity patterns) Subgroup C: Frontal Pole Network Subgroup D: Commissural and Projection Networks (further divided into D1 and D2). Recurrences were classified via post-contrast T1-weighted MRI as local, remote, ependymal. The Tract-to-Region Connectome (T-R-C) assessed the volumetric overlap between recurrence maps and main white matter bundles.

Results

Of 41 patients, a significant correlation emerged between tumor subgroup and recurrence type (p = 0.0003). Subgroup A predominantly showed remote recurrences (68%), while B2, B3, C, and D2 had mainly local recurrences. Subgroup D1 had a predominance of ependymal recurrences (66.7%). Local and remote recurrences largely conformed to adjacent white matter distributions, with variations in timing of recurrence and survival observed across different groups.

Conclusion

Our analysis, focused on exploring the spatial aspects of recurrence in relation to white matter anatomy, suggests that HGG recurrence patterns are strongly influenced by anatomical location and white matter architecture. Certain anatomical areas show a predisposition toward specific recurrence patterns. Recognizing these spatial dynamics may guide more precise surgical strategies, radiotherapy targeting, and recurrence risk assessment.