The impact of surgery in molecularly defined low-grade glioma: an integrated clinical, radiological and molecular analysis.

Abstract

Background

Extensive resections in low-grade glioma are associated with improved overall survival. However, WHO classification of gliomas has been completely revised and is now predominantly based on molecular criteria. This requires re-evaluation of the impact of surgery in molecularly defined low-grade glioma subtypes.

Methods

We included 228 adults who underwent surgery since 2003 for a supratentorial low-grade glioma. Pre-and postoperative tumor volumes were assessed with semi-automatic software on T2-weighted images. Targeted Next-Generation Sequencing was used to classify samples according to current WHO classification. Impact of postoperative volume on overall survival, corrected for molecular profile, was assessed using a Cox proportional-hazards model.

Results

Median follow-up was 5.79 years. In 39 (17.1%) of histopathologically classified glioma the subtype was revised after molecular analysis. Complete resection was achieved in 35 patients (15.4%), and in 54 patients (23.7%) only small residue (0.1–5.0 cm ³) remained. In multivariable analysis, postoperative volume was associated with overall survival with a HR of 1.01 (95% CI 1.002–1.02; p=0.016) per cm ³ increase in volume. The impact of postoperative volume was particularly strong in IDH mutated astrocytoma patients, where even very small postoperative volumes (0.1–5.0 cm) already negatively affected overall survival.

Conclusions

Our data provides the necessary re-evaluation of the impact of surgery in molecularly defined low-grade glioma and supports maximal resection as first-line treatment for molecularly defined low-grade glioma.

from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wNkX9P