Xiaojie Ding1, Zheng Wang2, Di Chen1, Yinyan Wang3, Zheng Zhao2, Chongran Sun4, Dikang Chen1, Chao Tang1,5, Ji Xiong6, Lingchao Chen1,5, Zhenwei Yao7, Ying Liu8, Xiaoqin Wang9, Daniel P Cahill10, John F de Groot11, Tao Jiang12,13, Yu Yao14,15, Liangfu Zhou1,5. 1. Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Mid Wulumuqi Road, Shanghai, China. 2. Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China. 3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China. 4. Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China. 5. Neurosurgical Immunology Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China. 6. Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China. 7. Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China. 8. Department of Pathology, Basic Medical Science, Fudan University, Shanghai, China. 9. Evidence Based Medicine Center, Fudan University, Shanghai, China. 10. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 11. Department of Neuro-Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA. jdegroot@mdanderson.org. 12. Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China. taojiang_1964@163.com. 13. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China. taojiang_1964@163.com. 14. Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Mid Wulumuqi Road, Shanghai, China. yu_yao@fudan.edu.cn. 15. Neurosurgical Immunology Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China. yu_yao@fudan.edu.cn.
Abstract
PURPOSE: Maximal surgical resection is associated with survival benefit in the majority of studies in adult diffuse glioma. This study aims to characterize the prognostic value of surgical resection in molecular subgroups of diffuse glioma. METHODS: 1178 patients with diffuse glioma from our centers and 422 from TCGA dataset were collected. The Kaplan-Meier analysis and multivariable Cox regression models were conducted to identify the prognostic value of surgical resection through different histological and molecular stratifications. RESULTS: Firstly, we confirmed progression-free survival (PFS) benefit associated with gross total resection (GTR) over sub-total resection (STR) in lower-grade glioma (HR 1.49; 95% CI 1.17-1.90; P = 0.001). Intriguingly however, we were unable to detect a significant PFS or overall survival (OS) benefit in oligodendroglioma (N = 397; HR 1.36; 95% CI 0.86-2.14; P = 0.19 and HR 1.05; 95% CI 0.55-1.99; P = 0.89, respectively). Secondly, when analyzed in molecular subgroups, we were similarly unable to detect a significant PFS or OS benefit in IDH MT/codel subgroup (N = 269; HR 1.47; 95% CI 0.92-2.34; P = 0.11 and HR 1.54; 95% CI 0.78-3.05; P = 0.21, respectively), oligodendroglioma with IDH MT/codel subgroup (N = 233; HR 1.33; 95% CI 0.79-2.21; P = 0.28 and HR 1.16; 95% CI 0.53-2.54; P = 0.70, respectively) or other relevant subgroups. TCGA validation also showed a significant survival benefit in astrocytoma rather than oligodendroglioma. Exploratory RNAseq analysis displayed that fewer cell proliferation-related gene expression features were specific to oligodendroglioma. CONCLUSION: These results suggest that the benefit of maximal surgery may be attenuated in patients within oligodendroglioma relevant subgroups because of the chemosensitive and indolent nature. The aggressive surgery accompanying with risk of neurologic morbidity may be unnecessary for these patients given the lack of survival benefit with gross total resection.
PURPOSE: Maximal surgical resection is associated with survival benefit in the majority of studies in adult diffuse glioma. This study aims to characterize the prognostic value of surgical resection in molecular subgroups of diffuse glioma. METHODS: 1178 patients with diffuse glioma from our centers and 422 from TCGA dataset were collected. The Kaplan-Meier analysis and multivariable Cox regression models were conducted to identify the prognostic value of surgical resection through different histological and molecular stratifications. RESULTS: Firstly, we confirmed progression-free survival (PFS) benefit associated with gross total resection (GTR) over sub-total resection (STR) in lower-grade glioma (HR 1.49; 95% CI 1.17-1.90; P = 0.001). Intriguingly however, we were unable to detect a significant PFS or overall survival (OS) benefit in oligodendroglioma (N = 397; HR 1.36; 95% CI 0.86-2.14; P = 0.19 and HR 1.05; 95% CI 0.55-1.99; P = 0.89, respectively). Secondly, when analyzed in molecular subgroups, we were similarly unable to detect a significant PFS or OS benefit in IDH MT/codel subgroup (N = 269; HR 1.47; 95% CI 0.92-2.34; P = 0.11 and HR 1.54; 95% CI 0.78-3.05; P = 0.21, respectively), oligodendroglioma with IDH MT/codel subgroup (N = 233; HR 1.33; 95% CI 0.79-2.21; P = 0.28 and HR 1.16; 95% CI 0.53-2.54; P = 0.70, respectively) or other relevant subgroups. TCGA validation also showed a significant survival benefit in astrocytoma rather than oligodendroglioma. Exploratory RNAseq analysis displayed that fewer cell proliferation-related gene expression features were specific to oligodendroglioma. CONCLUSION: These results suggest that the benefit of maximal surgery may be attenuated in patients within oligodendroglioma relevant subgroups because of the chemosensitive and indolent nature. The aggressive surgery accompanying with risk of neurologic morbidity may be unnecessary for these patients given the lack of survival benefit with gross total resection.
Entities:
Keywords:
Extent of resection; Glioma; Molecular subgroup; Prognostic value
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