Is Visible Aminolevulinic Acid-Induced Fluorescence an Independent Biomarker for Prognosis in Histologically Confirmed (World Health Organization 2016) Low-Grade Gliomas?
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BACKGROUND: Approximately 20% of low-grade gliomas (LGG) display visible protoporphyrin fluorescence during surgery after 5-aminolevulinic acid (5-ALA) administration. OBJECTIVE: To determine if fluorescence represents a prognostic marker in LGG. METHODS: Seventy-four consecutive patients with LGG (World Health Organization 2016) were operated on with 5-ALA. Fluorescent tissue was specifically biopsied. Tumor size, age, Karnofsky index, contrast-enhancement, fluorescence, and molecular factors (IDH1/IDH2-mutations, Ki67/MIB1 Index, 1p19q codeletions, ATRX, EGFR, p53 expression, and O 6 -methylguanine DNA methyltransferase promotor methylation), were related to progression-free survival (PFS), malignant transformation-free survival (MTFS) and overall survival (OS). RESULTS: Sixteen of seventy-four LGGs (21.6%) fluoresced. Fluorescence was partially related to weak enhancement on magnetic resonance imaging and increased (positron emission tomography)PET-FET uptake, but not to Karnofsky Performance Score, tumor size, or age. Regarding molecular markers, only EGFR expression differed marginally (fluorescing vs nonfluorescing: 19% vs 5%; P = .057). Median follow-up was 46.4 mo (95% confidence interval [CI]: 41.8-51.1). PFS, MTFS, and OS were shorter in fluorescing tumors (PFS: median 9.8 mo, 95% CI: 1.00-27.7 vs 45.8, 31.9-59.7, MTFS: 43.0 [27.5-58.5] vs 64.6 [57.7-71.5], median not reached, P = .015; OS: 51.6, [34.8-68.3] vs [68.2, 62.7-73.8], P = .002). IDH mutations significantly predicted PFS, MTFS, and OS. In multivariate analysis IDH status and fluorescence both independently predicted MTFS and OS. PFS was not independently predicted by fluorescence. CONCLUSION: This is the first report investigating the role of ALA-induced fluorescence in histologically confirmed LGG. Fluorescence appeared to be a marker for inherent malignant transformation and OS, independently of known prognostic markers. Fluorescence in LGG might be taken into account when deciding on adjuvant therapies.
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Comparison between fluorescing and non-fluorescing low-grade gliomas revealed significant differences in gadolinium enhancement, tumor cell proliferation, and 18F-FET PET uptake.
“A comparison between fluorescing and non-fluorescing low-grade gliomas revealed significant differences in gadolinium enhancement, tumor cell proliferation, and 18F-fluoroethyl-l-tyrosine (18F-FET) PET uptake, suggesting a distinction in tumor cell biology and tumor microenvironment [52,53].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [52]
The Results (Patient and Imaging Characteristics; page not supplied) report significant differences between fluorescing and non-fluorescing low-grade gliomas in MRI contrast enhancement (P = .001) and PET uptake (P = .009). But the same section says the median MIB proliferation index did not differ between the groups, contrary to the claimed difference in tumor cell proliferation. (LLM, conf=0.91)
Experimental — accuracy not yet measuredThe association between positive PpIX fluorescence and gadolinium contrast enhancement highlights the importance of the blood-brain barrier in PpIX fluorescence positivity.
“Particularly, the association between positive PpIX fluorescence and gadolinium contrast enhancement highlights the importance of the blood-brain barrier (BBB) in PpIX fluorescence positivity.”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [52]
Patients with low-grade gliomas that show PpIX fluorescence often have poor prognoses compared to patients whose tumors do not fluoresce.
“Nevertheless, patients with low-grade gliomas that do show PpIX fluorescence often have poor prognoses compared to patients whose tumors do not fluoresce, prompting the possible use of PpIX fluorescence as a prognostic marker for low-grade gliomas [51,52].”
From 5-Aminolevulinic Acid as a Theranostic Agent for Tumor Fluorescence Imaging and Photodynamic Therapy (2023) · cites this paper as [52]
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Machine learning-based prediction of glioma margin from 5-ALA induced PpIX fluorescence spectroscopy
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中洲, 敏., 中洲庸子, Nakasu, S., & Nakasu, Y. (n.d.) · Institutional Repositories DataBase (IRDB)
- Authors
- Jaber, M., Ewelt, C., Wölfer, J., Brokinkel, B., Thomas, C., Hasselblatt, M., Grauer, O., & Stummer, W.
- Affiliations
- University Hospital Münster (DE)
- Corresponding author
- Stummer, Walter
- ORCID
- Venue
- Neurosurgery
- Published
- 2018-08-09
- Volume
- 84
- Issue
- 6
- Pages
- 1214-1224
- ISSN
- 0148-396X (ISSN-L)
- 1524-4040
- PMC
- PMC6537633
- OpenAlex
- W2886579043
- Cited by
- 66
- References
- 61
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 4 · 2023: 4 · 2022: 18 · 2021: 15 · 2020: 7 · 2019: 10 · 2018: 1
- FWCI
- 4.68
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Neurosurgery (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Health Sciences › Medicine › Hematology › Acute Myeloid Leukemia Research
- Keywords
- low-grade glioma, 5-aminolevulinic acid fluorescence, prognostic factors, IDH mutation, malignant transformation, progression-free survival, overall survival, EGFR expression, 1p/19q codeletion, ATRX, p53, MGMT promoter methylation, MRI contrast enhancement
- MeSH terms
- Adult, Aminolevulinic Acid, Biopsy, Brain Neoplasms, Female, Fluorescence, Glioma, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Protoporphyrins, Biomarkers, Karnofsky Performance Status, Positron-Emission Tomography
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