TY - JOUR T1 - Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1149 LP - 1155 DO - 10.3174/ajnr.A6102 VL - 40 IS - 7 AU - S.H. Patel AU - A.G. Bansal AU - E.B. Young AU - P.P. Batchala AU - J.T. Patrie AU - M.B. Lopes AU - R. Jain AU - C.E. Fadul AU - D. Schiff Y1 - 2019/07/01 UR - http://www.ajnr.org/content/40/7/1149.abstract N2 - BACKGROUND AND PURPOSE: Diffuse lower-grade gliomas are classified into prognostically meaningful molecular subtypes. We aimed to determine the impact of surgical resection on overall survival in lower-grade glioma molecular subtypes.MATERIALS AND METHODS: For 172 patients with lower-grade gliomas (World Health Organization grade II or III), pre- and postsurgical glioma volumes were determined using a semiautomated segmentation software based on FLAIR or T2-weighted MR imaging sequences. The association of pre- and postsurgical glioma volume and the percentage of glioma resection with overall survival was determined for the entire cohort and separately for lower-grade glioma molecular subtypes based on isocitrate dehydrogenase (IDH) and 1p/19q status, after adjustment for age, sex, World Health Organization grade, chemotherapy administration, and radiation therapy administration.RESULTS: For the entire cohort, postsurgical glioma volume (hazard ratio, 1.80; 95% CI, 1.18–2.75; P = .006) and the percentage of resection (hazard ratio, 3.22; 95% CI, 1.79–5.82; P < .001) were associated with overall survival. For IDH-mutant 1p/19q-codeleted oligodendrogliomas, the percentage of resection (hazard ratio, 6.69; 95% CI, 1.57–28.46; P = .01) was associated with overall survival. For IDH-mutant 1p/19q-noncodeleted astrocytomas, presurgical glioma volume (hazard ratio, 3.20; 95% CI, 1.22–8.39; P = .018), postsurgical glioma volume (hazard ratio, 2.33; 95% CI, 1.32–4.12; P = .004), and percentage of resection (hazard ratio, 4.34; 95% CI, 1.74–10.81; P = .002) were associated with overall survival. For IDH-wild-type lower-grade gliomas, pre-/postsurgical glioma volume and percentage of resection were not associated with overall survival.CONCLUSIONS: The extent of surgical resection has a differential survival impact in patients with lower-grade gliomas based on their molecular subtype. IDH-mutant lower-grade gliomas benefit from a greater extent of surgical resection, with the strongest impact observed for IDH-mutant 1p/19q-noncodeleted astrocytomas.LGGlower-grade gliomamutmutationWHOWorld Health OrganizationIDHmut-NoncodelLGGs with an IDH mutation but lacking 1p/19q codeletionIDHmut-CodelLGGs with an IDH mutation and codeletion of chromosome arms 1p and 19qIDHwtLGGs in IDH-wild-type subgroup ER -