组织病理学特征和分子生物标志物已被研究为潜在的预后因素。研究IDH突变（IDHmt）脑胶质瘤的临床特征、分子表型和生存预后，其中包括组蛋白H3变化（H3-alterations）。共收集了236名和657名具有全外显子测序数据的患者分别来自中国脑胶质瘤基因组图谱和癌症基因组图谱数据库。使用以组蛋白H3状态分层的Kaplan-Meier生存曲线对脑胶质瘤患者进行生存分析。使用单因素和多因素分析来确定组蛋白H3状态与其它临床病理因素与IDH突变脑胶质瘤患者的生存之间的关联。在这2个组中，H3变化的弥漫性胶质瘤更有可能是高级别的（分别为P = .025和P = .021）。与组蛋白H3野生型相比，H3-alteration的IDHmt脑胶质瘤患者的预期寿命显著较短（分别为P = .041和P = .008）。在中国脑胶质瘤基因组图谱中，Karnofsky表现评分≤ 80（HR 2.394，95％CI 1.257-4.559，P = .008），切除范围（HR 0.971，95％CI 0.957-0.986，P <.001），高WHO级别（HR 6.938，95％CI 2.787-17.269，P <.001），H3-alteration（HR 2.482，95％CI 1.183-4.981，P = .016）和1p/19q共删除（HR 0.169，95％CI 0.073-0.390，P <.001）与IDHmt脑胶质瘤独立相关。在癌症基因组图谱中，年龄（HR 1.034，95％CI 1.008-1.061，P = .010），高WHO级别（HR 2.365，95％CI 1.263-4.427，P = .007）和H3-alteration（HR 2.501，95％CI 1.312-4.766，P = .005）是IDHmt脑胶质瘤的独立相关因素。在临床实践中，确定和评估组蛋白H3状态可能有助于改善预后预测，并为这些患者亚组制定治疗策略。版权所有©2023 The Author(s)，由 Wolters Kluwer Health, Inc. 代表神经外科医生大会发表。

Histopathological features and molecular biomarkers have been studied as potential prognostic factors.To investigate the clinical features, molecular phenotypes, and survival prognosis of isocitrate dehydrogenase (IDH)-mutant (IDHmt) gliomas with histone H3 alterations (H3-alterations).A total of 236 and 657 patients with whole-exome sequencing data were separately collected from the Chinese Glioma Genome Atlas and The Cancer Genome Atlas databases. Survival analysis of patients with glioma was performed using Kaplan-Meier survival curves stratified by histone H3 status. Univariate and multivariate analyses were used to identify the associations between histone H3 status and other clinicopathological factors with survival in patients with IDH-mutant gliomas.Diffuse gliomas with H3 alterations are more likely to be high grade in 2 cohorts (P = .025 and P = .021, respectively). IDHmt glioma patients with H3-alteration had significantly less life expectancy than histone H3 wild-type (P = .041 and P = .008, respectively). In the Chinese Glioma Genome Atlas cohort, Karnofsky performance scores ≤ 80 (HR 2.394, 95% CI 1.257-4.559, P = .008), extent of resection (HR 0.971, 95% CI 0.957-0.986, P < .001), high WHO grade (HR 6.938, 95% CI 2.787-17.269, P < .001), H3-alteration (HR 2.482, 95% CI 1.183-4.981, P = .016), and 1p/19q codeletion (HR 0.169, 95% CI 0.073-0.390, P < .001) were independently associated with IDHmt gliomas. In the The Cancer Genome Atlas cohort, age (HR 1.034, 95% CI 1.008-1.061, P = .010), high WHO grade (HR 2.365, 95% CI 1.263-4.427, P = .007), and H3-alteration (HR 2.501, 95% CI 1.312-4.766, P = .005) were independently associated with IDHmt gliomas.Identification and assessment of histone H3 status in clinical practice might help improve prognostic prediction and develop therapeutic strategies for these patient subgroups.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Congress of Neurological Surgeons.