The benefit of early surgery on overall survival in incidental low-grade glioma patients: A multicenter study

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 la...

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Published in:Neuro-oncology (Charlottesville, Va.) Va.), 2022-04, Vol.24 (4), p.624-638
Main Authors: Ius, Tamara, Ng, Sam, Young, Jacob S, Tomasino, Barbara, Polano, Maurizio, Ben-Israel, David, Kelly, John J P, Skrap, Miran, Duffau, Hugues, Berger, Mitchel S
Format: Article
Language:English
Subjects:
Brain Neoplasms - pathology
Cancer
Clinical Investigations
Glioma - pathology
Human health and pathology
Humans
Life Sciences
Neurons and Cognition
Neurosurgical Procedures - methods
Retrospective Studies
Santé publique et épidémiologie
Surgery
Treatment Outcome
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Summary: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.
ISSN:1522-8517
1523-5866
DOI:10.1093/neuonc/noab210