The publication of the 2016 World Health Organization Classification of Tumors of the Central Nervous System (2016 WHO CNS) represented a major change in the classification of brain tumors. It is essential to determine the IDH and 1p/19q statuses of diffuse gliomas to ensure that the final diagnosis is accurate. The integrated diagnostic method outlined in the 2016 WHO CNS has enabled more precise prediction of the prognoses of diffuse gliomas. However, there are further two points that need to be addressed when planning future clinical trials. The first is the problems with the WHO grading system for diffuse gliomas. The second is that examinations for IDH mutations and 1p/19q co-deletion are not sufficient on their own to accurately predict the prognosis of diffuse glioma patients. Risk of an IDH-mut diffuse glioma should be evaluated based on a combination of clinical factors (age and the resection rate), molecular factors (the presence/absence of CDKN2A deletion), and histological factors (morphology and the mitotic index). Glioblastoma (GBM) have also been classified according to their IDH status; however, the frequency of IDH gene mutations is only 5-10% in GBM. Other molecular markers such as MGMT methylation, pTERT mutations and EGFR amplification could be more important to predict clinical outcome. Therefore, the next revision of the classification of diffuse gliomas will propose a detailed classification based on additional markers. In the near future, treatments for diffuse gliomas will be chosen according to the molecular profile of each tumor.

中文翻译：

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修订 WHO 弥漫性胶质瘤分类的临床影响和相关的未来问题。

2016年世界卫生组织中枢神经系统肿瘤分类（2016 WHO CNS）的发布代表了脑肿瘤分类的重大变化。必须确定弥漫性胶质瘤的 IDH 和 1p/19q 状态，以确保最终诊断准确。2016 年 WHO CNS 中概述的综合诊断方法能够更精确地预测弥漫性胶质瘤的预后。然而，在规划未来的临床试验时，还有两点需要解决。首先是WHO弥漫性胶质瘤分级系统的问题。二是IDH突变和1p/19q共缺失的检查本身不足以准确预测弥漫性胶质瘤患者的预后。应根据临床因素（年龄和切除率）、分子因素（是否存在 CDKN2A 缺失）和组织学因素（形态学和有丝分裂指数）来评估 IDH-mut 弥漫性胶质瘤的风险。胶质母细胞瘤 (GBM) 也根据其 IDH 状态进行分类；然而，GBM 中 IDH 基因突变的频率仅为 5-10%。MGMT 甲基化、pTERT 突变和 EGFR 扩增等其他分子标志物对于预测临床结果可能更为重要。因此，弥漫性胶质瘤分类的下一次修订将提出基于附加标记的详细分类。在不久的将来，将根据每个肿瘤的分子特征选择弥漫性胶质瘤的治疗方法。分子因素（CDKN2A 缺失的存在/不存在）和组织学因素（形态学和有丝分裂指数）。胶质母细胞瘤 (GBM) 也根据其 IDH 状态进行分类；然而，GBM 中 IDH 基因突变的频率仅为 5-10%。MGMT 甲基化、pTERT 突变和 EGFR 扩增等其他分子标志物对于预测临床结果可能更为重要。因此，弥漫性胶质瘤分类的下一次修订将提出基于附加标记的详细分类。在不久的将来，将根据每个肿瘤的分子特征选择弥漫性胶质瘤的治疗方法。分子因素（CDKN2A 缺失的存在/不存在）和组织学因素（形态学和有丝分裂指数）。胶质母细胞瘤 (GBM) 也根据其 IDH 状态进行分类；然而，GBM 中 IDH 基因突变的频率仅为 5-10%。MGMT 甲基化、pTERT 突变和 EGFR 扩增等其他分子标志物对于预测临床结果可能更为重要。因此，弥漫性胶质瘤分类的下一次修订将提出基于附加标记的详细分类。在不久的将来，将根据每个肿瘤的分子特征选择弥漫性胶质瘤的治疗方法。在GBM中IDH基因突变的频率仅为5-10%。MGMT 甲基化、pTERT 突变和 EGFR 扩增等其他分子标志物对于预测临床结果可能更为重要。因此，弥漫性胶质瘤分类的下一次修订将提出基于附加标记的详细分类。在不久的将来，将根据每个肿瘤的分子特征选择弥漫性胶质瘤的治疗方法。在GBM中IDH基因突变的频率仅为5-10%。MGMT 甲基化、pTERT 突变和 EGFR 扩增等其他分子标志物对于预测临床结果可能更为重要。因此，弥漫性胶质瘤分类的下一次修订将提出基于附加标记的详细分类。在不久的将来，将根据每个肿瘤的分子特征选择弥漫性胶质瘤的治疗方法。