Tamara Ius1, Sam Ng2,3, Jacob S Young4, Barbara Tomasino5, Maurizio Polano6, David Ben-Israel7,8, John J P Kelly7,8, Miran Skrap1, Hugues Duffau2,3, Mitchel S Berger4. 1. Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy. 2. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France. 3. INSERM U1191, Team "Plasticity of Central Nervous System, Human Stem Cells and Glial Tumors", Institute of Functional Genomics, Montpellier, France. 4. Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, CA, USA. 5. Scientific Institute IRCCS "Eugenio Medea", Polo FVG, San Vito al Tagliamento, Italy. 6. Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy. 7. Division of Neurosurgery, University of Calgary, Calgary, Alberta, Canada. 8. Arne Charbonneau Cancer Institute, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND: The role of surgery for incidentally discovered diffuse incidental low-grade gliomas (iLGGs) is debatable and poorly documented in current literature. OBJECTIVE: The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population. METHODS: Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR). RESULTS: The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2%, respectively. OS was significantly longer for patients with a lower preoperative tumor volume (P = .001) and higher extent of resection (EOR) (P = .037), regardless the WHO-defined molecular class (P = .2). In the final model, OS was influenced only by the preoperative tumor volume (P = .006), while TR by early surgery (P = .028). A negative association was found between preoperative tumor volumes and EOR (rs = -0.44, P < .001). The median preoperative tumor volume was 15 cm3. The median EOR was 95%. Total or supratotal resection of T2-FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high-grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases. CONCLUSIONS: This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favor of early surgery for these lesions.
BACKGROUND: The role of surgery for incidentally discovered diffuse incidental low-grade gliomas (iLGGs) is debatable and poorly documented in current literature. OBJECTIVE: The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population. METHODS: Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR). RESULTS: The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2%, respectively. OS was significantly longer for patients with a lower preoperative tumor volume (P = .001) and higher extent of resection (EOR) (P = .037), regardless the WHO-defined molecular class (P = .2). In the final model, OS was influenced only by the preoperative tumor volume (P = .006), while TR by early surgery (P = .028). A negative association was found between preoperative tumor volumes and EOR (rs = -0.44, P < .001). The median preoperative tumor volume was 15 cm3. The median EOR was 95%. Total or supratotal resection of T2-FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high-grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases. CONCLUSIONS: This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favor of early surgery for these lesions.
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