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

Neuro-Oncology - Tập 23 Số 5 - Trang 812-826 - 2021
Marco Rossi1,2, Lorenzo Gay1,2, Federico Ambrogi3, Marco Conti Nibali1,2, Tommaso Sciortino1,2, Guglielmo Puglisi1,2, Antonella Leonetti1,2, Cristina Mocellini4, Manuela Caroli5, Susanna Cordera6, Matteo Simonelli7, Federico Pessina7, Pierina Navarria7, Andrea Pace8, Riccardo Soffietti9, Roberta Rudà9, Marco Riva1,2, Lorenzo Bello1,2
1IRCCS Istituto Ortopedico Galeazzi, Neurosurgical Oncology Unit, Milano, Italy
2Neurosurgical Oncology Unit, Dept of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy
3Laboratory of Medical Statistics, Biometry and Epidemiology “G.A.Maccararo,” Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
4Neuro-oncologia, Divisione di Neurologia, Ospedale Santa Croce e Carle, Cuneo, Italy
5Neurochirurgia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milano, Italy
6Neuro-oncologia, Divisione di Neurologia, Ospedale Regionale Parini, Aosta, Italy
7Humanitas Cancer Center, Humanitas Research Hospital, IRCCS, Rozzano, Italy
8Neuro-Oncologia, Istituto Nazionale Tumori Regina Elena, Roma, Italy
9Neuro-Oncologia, Città della Salute e della Scienza, Università di Torino, Torino, Italy

Tóm tắt

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.

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Neuro-Oncology

Tập 23 Số 5

812-826

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