RT Journal Article
SR Electronic
T1 Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A6102
A1 Patel, S.H.
A1 Bansal, A.G.
A1 Young, E.B.
A1 Batchala, P.P.
A1 Patrie, J.T.
A1 Lopes, M.B.
A1 Jain, R.
A1 Fadul, C.E.
A1 Schiff, D.
YR 2019
UL http://www.ajnr.org/content/early/2019/06/27/ajnr.A6102.abstract
AB 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