Background: Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) enables the intraoperative visualization of glioma. However, its effectiveness varies based on tumor subtype and molecular profile, posing challenges for achieving complete resection. Our systematic review aims to explore the relationship between IDH mutation status and intraoperative fluorescence visualization. Importantly, this is the first study to propose that vorasidenib, an emerging IDH-targeting agent, could enhance 5-ALA-guided surgery, marking a novel direction for translational research.Methods: A systematic literature search was conducted using the PubMed, Cochrane Library, Scopus and Web of Science databases up to May 2025, following PRISMA guidelines. The primary outcomes included fluorescence detection rates across different glioma subtypes and their correlation with IDH mutation status. Secondary outcomes comprised surgical efficacy measures such as gross total resection (GTR), overall survival (OS), and progression-free survival (PFS). Additionally, we analyzed the metabolic consequences of IDH mutations and evaluated the potential role of vorasidenib in enhancing 5-ALA-induced fluorescence.Results: Seven studies including 621 patients included in the final analysis. Fluorescence detection was nearly universal in WHO grade 4 gliomas (94–100%), but lower in grade 3 (43–85%) and rare in grade 2 (7–26%). Several cohorts reported reduced fluorescence in IDH-mutant gliomas, although this was not consistent across all studies. In high-grade gliomas, visible fluorescence correlated with higher GTR rates and, in some series, longer OS. Conversely, in lower-grade IDH-mutant gliomas, fluorescence did not increase GTR and was associated with worse PFS and OS.Conclusions: The effectiveness of 5-ALA-guided fluorescence in glioma surgery is significantly influenced by both tumor grade and IDH mutation status. Vorasidenib may represent a potential avenue for modulating tumor metabolism and enhancing intraoperative fluorescence in IDH-mutant gliomas, a hypothesis that warrants further experimental validation.
背景：使用5-氨基乙酰丙酸（5-ALA）的荧光引导手术可实现胶质瘤的术中可视化。然而，其效果因肿瘤亚型和分子特征而异，这为实现完全切除带来了挑战。本系统综述旨在探讨IDH突变状态与术中荧光可视化之间的关系。值得注意的是，本研究首次提出新兴的IDH靶向药物伏拉西地尼可能增强5-ALA引导的手术，这标志着转化研究的一个新方向。 方法：遵循PRISMA指南，在PubMed、Cochrane Library、Scopus和Web of Science数据库中进行了截至2025年5月的系统性文献检索。主要结局指标包括不同胶质瘤亚型的荧光检出率及其与IDH突变状态的相关性。次要结局指标包括手术疗效指标，如大体全切除率、总生存期和无进展生存期。此外，我们分析了IDH突变的代谢后果，并评估了伏拉西地尼在增强5-ALA诱导荧光方面的潜在作用。 结果：最终分析纳入7项研究，共621例患者。WHO 4级胶质瘤的荧光检出率几乎普遍存在（94-100%），但在3级胶质瘤中较低（43-85%），在2级胶质瘤中罕见（7-26%）。多项队列研究报告IDH突变胶质瘤的荧光减弱，尽管并非所有研究结果一致。在高级别胶质瘤中，可见荧光与较高的大体全切除率相关，并且在部分系列研究中与较长的总生存期相关。相反，在低级别IDH突变胶质瘤中，荧光并未提高大体全切除率，且与较差的无进展生存期和总生存期相关。 结论：5-ALA引导的荧光在胶质瘤手术中的有效性显著受肿瘤分级和IDH突变状态的影响。伏拉西地尼可能代表了一种调节肿瘤代谢并增强IDH突变胶质瘤术中荧光的潜在途径，这一假说值得进一步的实验验证。
肿瘤(癌症)患者之家