A multi-institutional analysis of factors influencing surgical outcomes for patients with newly diagnosed grade I gliomas.

A multi-institutional analysis of factors influencing surgical outcomes for patients with newly diagnosed grade I gliomas.:

A multi-institutional analysis of factors influencing surgical outcomes for patients with newly diagnosed grade I gliomas.

World Neurosurg. 2019 Dec 31;:

Authors: Yahanda AT, Patel B, Sutherland G, Honeycutt J, Jensen RL, Smyth MD, Limbrick DD, Dacey RG, Dowling JL, Dunn GP, Kim AH, Leuthardt EC, Rich KM, Zipfel GJ, Leonard JR, Cahill DP, Shah MV, Abram SR, Evans J, Tao Y, Chicoine MR

Abstract

OBJECTIVE: To assess the impact of intraoperative magnetic resonance imaging (iMRI), extent of resection (EOR), and other factors on overall survival (OS) and progression-free survival (PFS) for patients with newly diagnosed grade I gliomas.

METHODS: A multicenter database was queried to identify patients with grade I gliomas. Retrospective analyses assessed the impact of patient, treatment, and tumor characteristics on OS and PFS.

RESULTS: Two-hundred eighty-four patients underwent treatment for grade I gliomas, including 248 resections (205 with iMRI, 43 without), 23 biopsies, and 13 laser interstitial thermal therapy treatments. Log-rank analyses of Kaplan Meier plots showed improved 5-year OS (p=.0107) and PFS (p=.0009) with increasing EOR, and a trend towards improved 5-year OS for patients with lower American Society of Anesthesiologists (ASA) score (p=.0528). Greater EOR was associated with significantly increased 5-year PFS for pilocytic astrocytoma (p<.0001), but not for ganglioglioma (p=.10) or dysembryoplastic neuroepithelial tumor (p=.57). Temporal tumors (p=.04) and location of 'other' (p=.04) were associated with improved PFS, and occipital/parietal tumors (p=.02) were associated with decreased PFS when compared to all other locations. Additional tumor resection was performed after iMRI in 49.7% of cases utilizing iMRI, which produced gross total resection (GTR) in 64% of these additional resection cases.

CONCLUSIONS: Patients with grade I gliomas have extended OS and PFS, which correlates positively with increasing EOR, especially for patients with pilocytic astrocytoma. Intraoperative MRI may increase EOR, indicated by the rate of GTR after iMRI use, but was not independently associated with increased OS or PFS.

PMID: 31901497 [PubMed - as supplied by publisher]