ArticleJournal of neuro-oncology2026
Malignant transformation of lower-grade glioma: contrast enhancement, extent of resection, and the natural history under interval-censored analysis.
Article in Journal of neuro-oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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24 authors.
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Abstract
purposeMalignant transformation (MT) is the principal driver of mortality in lower-grade glioma (LGG), yet its preoperative determinants and timing remain poorly defined. We quantified imaging elements of MT and its timing, correcting for bias in dating transformation.
methodsWe evaluated contrast enhancement (CE), tumour volume and 99 radiomic features in 155 patients with WHO grade 2-3 LGG, radiologically low-grade at diagnosis with at most minimal enhancement (77 transformations; median surveillance among non-transformers 4.8 years). Because MT is ascertainable only between scans, timing was modelled as interval-censored across four complementary models, with extent of resection (EOR) time-varying.
resultsCE at diagnosis was the strongest predictor of MT, exceeding tumour volume and a co-modelled 99-feature radiomic panel (Bayesian HR 22.1, 95% CrI 10.5-53.2); conditioned on transformation-free survival to six months, HR 5.65 (95% CI 2.23-14.31). No radiomic feature survived shrinkage or native interval-censoring. Initial enhancement predicted post-surgical transformation independently of grade, IDH status and EOR, even after gross-total resection (GTR), itself associated with a two-thirds lower hazard (HR 0.32, 95% CI 0.13-0.77). Interval censoring proved material: conventional dating overstated the hazard four-fold.
conclusionCE at diagnosis predicted transformation risk and timing. It remained predictive after GTR removed the enhancing tissue, a postoperative role not previously recognised. The signal was present in each integrated tumour type and survived adjustment for grade, IDH status and EOR, may reflect intrinsic tumour biology and could refine postoperative risk estimation. GTR was the only modifiable determinant. These are the first interval-censored estimates of MT timing.
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