With multiple targeted small agents entering late-stage clinical trials, we approach a potential turning point in the clinical management of pediatric gliomas, and an accurate and rational basis for the stratification of this patient population is of critical importance. We commend Lassaletta and colleagues¹ for their recent article that outlines the molecular-genetic and clinical features of a large, institutional cohort with these tumors, and agree with many of the issues raised; however, we feel that some of the conclusions drawn by Lassaletta et al¹ are not fully supported by the data, and that, at times, the clarity and precision that are required for the optimal planning of clinical studies, including patient stratification, are missing. It is clear from this and many other reports that V600E-mutant low-grade gliomas (LGGs) comprise a heterogeneous group of tumors, with divergent histology, location, cooperating genetic alterations, and outcomes. To attempt to group these together under one umbrella designation, in our opinion, is an oversimplification—the presence of V600E alone does not define a distinct entity. The importance of a more precise distinction is highlighted in some of the details of the survival analyses performed Lassaletta and colleagues.

中文翻译：

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单独的BRAF V600E状态不足以作为小儿低度神经胶质瘤的预后生物标志物

随着多种靶向小型药物进入后期临床试验，我们接近了小儿神经胶质瘤临床管理中的一个潜在转折点，对这一患者群体进行分层的准确而合理的基础至关重要。我们赞扬Lassaletta及其同事¹的最新文章，该文章概述了与这些肿瘤相关的大型机构队列的分子遗传学和临床特征，并同意许多提出的问题；但是，我们认为Lassaletta等[ ^1]得出的某些结论数据未完全支持，有时甚至缺少最佳临床研究计划（包括患者分层）所需的清晰度和精确度。从本报告和许多其他报告中可以清楚地看出，V600E突变型低级神经胶质瘤（LGG）包括一组异质性肿瘤，具有不同的组织学，位置，协同的遗传改变和结局。我们认为，将这些名称归为一个总括名称是一种过分的简化-仅V600E的存在并不能定义一个不同的实体。Lassaletta和同事进行的生存分析的某些细节中强调了更精确区分的重要性。