Association of supratotal resection with progression-free survival, malignant transformation, and overall survival in lower-grade gliomas

Author:

Rossi Marco12,Gay Lorenzo12,Ambrogi Federico3ORCID,Conti Nibali Marco12,Sciortino Tommaso12,Puglisi Guglielmo12ORCID,Leonetti Antonella12,Mocellini Cristina4,Caroli Manuela5,Cordera Susanna6,Simonelli Matteo7,Pessina Federico7,Navarria Piera7,Pace Andrea8,Soffietti Riccardo9,Rudà Roberta9,Riva Marco12ORCID,Bello Lorenzo12

Affiliation:

1. Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy

2. IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy

3. Laboratory of Medical Statistics, Biometry and Epidemiology “G.A.Maccararo,” Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy

4. Neuro-oncologia, Divisione di Neurologia, Ospedale Santa Croce e Carle, Cuneo, Italy

5. Neurochirurgia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy

6. Neuro-oncologia, Divisione di Neurologia, Ospedale Regionale Parini, Aosta, Italy

7. Humanitas Cancer Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy

8. Neuro-Oncologia, Istituto Nazionale Tumori Regina Elena, Roma, Italy

9. Neuro-Oncologia, Città della Salute e della Scienza, Università di Torino, Torino, Italy

Abstract

Abstract Background Supratotal resection is advocated in lower-grade gliomas (LGGs) based on theoretical advantages but with limited verification of functional risk and data on oncological outcomes. We assessed the association of supratotal resection in molecularly defined LGGs with oncological outcomes. Methods Included were 460 presumptive LGGs; 404 resected; 347 were LGGs, 319 isocitrate dehydrogenase (IDH)–mutated, 28 wildtype. All patients had clinical, imaging, and molecular data. Resection aimed at supratotal resection without any patient or tumor a priori selection. The association of extent of resection (EOR), categorized on volumetric fluid attenuated inversion recovery images as residual tumor volume, along with postsurgical management with progression-free survival (PFS), malignant (M)PFS, and overall survival (OS) assessed by univariate, multivariate, and propensity score analysis. The study mainly focused on IDH-mutated LGGs, the “typical LGGs.” Results Median follow-up was 6.8 years (interquartile range, 5–8). Out of 319 IDH-mutated LGGs, 190 (59.6%) progressed, median PFS: 4.7 years (95% CI: 4–5.3). Total and supratotal resection obtained in 39% and 35% of patients with IDH1-mutated tumors. In IDH-mutated tumors, most patients in the partial/subtotal group progressed, 82.4% in total, only 6 (5.4%) in supratotal. Median PFS was 29 months (95% CI: 25–36) in subtotal, 46 months (95% CI: 38–48) in total, while at 92 months, PFS in supratotal was 94.0%. There was no association with molecular subtypes and grade. At random forest analysis, PFS strongly associated with EOR, radiotherapy, and previous treatment. In the propensity score analysis, EOR associated with PFS (hazard ratio, 0.03; 95% CI: 0.01–0.13). MPFS occurred in 32.1% of subtotal total groups; 1 event in supratotal. EOR, grade III, previous treatment correlated to MPFS. At random forest analysis, OS associated with EOR as well. Conclusions Supratotal resection strongly associated with PFS, MPFS, and OS in LGGs, regardless of molecular subtypes and grade, right from the beginning of clinical presentation.

Funder

AIRC

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Clinical Neurology,Oncology

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