Characterization and clinical implications of different malignant transformation patterns in diffuse low‐grade gliomas

Malignant transformation (MT) of low‐grade gliomas (LGGs) to a higher‐grade variant seems inevitable, yet it remains unclear which LGG patients will progress to grade 3 or even directly to grade 4 after receiving a long course of treatment. To elucidate this, we conducted a retrospective cohort study based on 229 adults with recurrent LGG. Our study aimed to disclose the characteristics of different MT patterns and to build predictive models for patients with LGG. Patients were allocated into group 2–2 (n = 81, 35.4%), group 2–3 (n = 91, 39.7%), and group 2–4 (n = 57, 24.9%), based on their MT patterns. Patients who underwent MT showed lower Karnofsky performance scale (KPS) scores, larger tumor sizes, smaller extents of resection (EOR), higher Ki‐67 indices, lower rates of 1p/19q codeletion, but higher rates of subventricular involvement, radiotherapy, chemotherapy, astrocytoma, and post‐progression enhancement (PPE) compared with those in group 2–2 (p