{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:05:55Z","timestamp":1789049155645,"version":"build-2803163510"},"reference-count":29,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Brain and Behavior"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The 2021 WHO classification reclassified \u201cIDH\u2010mutant glioblastoma (GBM)\u201d as \u201cAstrocytoma, IDH\u2010mutant, grade 4.\u201d This study aims to provide real\u2010world validation of this reclassification using the specific ICD\u2010O\u20103 code (9445\/3) from the Surveillance, Epidemiology, and End Results (SEER) \u201cTransition Era\u201d (2018\u20132022) and develop a machine learning (ML)\u2010based prognostic model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients diagnosed with IDH\u2010mutant GBM (9445\/3) and GBM NOS (9440\/3) were identified. Propensity Score Matching (PSM) and Inverse Probability of Treatment Weighting (IPTW) were employed to minimize bias. A doubly robust Cox regression model was constructed to quantify survival benefits. Nine ML algorithms were integrated to develop a prognostic signature, which was interpreted using SHAP (Shapley Additive exPlanations) analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 13,443 patients, 312 were IDH\u2010mutant. After matching, the IDH\u2010mutant group exhibited significantly superior overall survival (OS) and cancer\u2010specific survival (CSS) (\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). IDH mutation emerged as a potent independent favorable prognostic factor, associated with a 65.0% lower mortality risk (HR = 0.350,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001). Subgroup analysis confirmed robust benefits from chemotherapy. The Random Forest (RF) model achieved the best performance (Test AUC = 0.698). SHAP analysis identified IDH status, chemotherapy, and age as the top predictors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides compelling evidence in support of the clinical rationale for the WHO 2021 reclassification. Despite a favorable prognosis, aggressive multimodal therapy was strongly associated with improved survival, though potential indication bias necessitates cautious interpretation and prospective validation. The developed ML model serves as a robust tool for personalized risk stratification.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/brb3.71641","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T04:54:46Z","timestamp":1786510486000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Real\u2010World Validation of the Clinical Distinctiveness of IDH\u2010Mutant Glioblastoma in the SEER Transition Era: A Population\u2010Based Study Integrating Machine Learning"],"prefix":"10.1002","volume":"16","author":[{"given":"Dewei","family":"Du","sequence":"first","affiliation":[{"name":"Department of Neurosurgery Affiliated Hospital of North Sichuan Medical College  Nanchong China"},{"name":"Department of Neurosurgery Liangping People's Hospital of Chongqing  Chongqing 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