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Hervey-Jumper, Shawn L.; Zhang, Yalan; Phillips, Joanna J.; Morshed, Ramin A.; Young, Jacob S.; McCoy, Lucie; Lafontaine, Marisa; Luks, Tracy; Ammanuel, Simon; Kakaizada, Sofia; Egladyous, Andrew; Gogos, Andrew; Villanueva-Meyer, Javier; Shai, Anny; Warrier, Gayathri; Rice, Terri; Crane, Jason; Wrensch, Margaret; Wiencke, John K.; Daras, Mariza; Oberheim Bush, Nancy Ann; Taylor, Jennie W.; Butowski, Nicholas; Clarke, Jennifer; [...]

Interactive Effects of Molecular, Therapeutic, and Patient Factors on Outcome of Diffuse Low-Grade Glioma

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  • Media type: E-Article
  • Title: Interactive Effects of Molecular, Therapeutic, and Patient Factors on Outcome of Diffuse Low-Grade Glioma
  • Contributor: Hervey-Jumper, Shawn L.; Zhang, Yalan; Phillips, Joanna J.; Morshed, Ramin A.; Young, Jacob S.; McCoy, Lucie; Lafontaine, Marisa; Luks, Tracy; Ammanuel, Simon; Kakaizada, Sofia; Egladyous, Andrew; Gogos, Andrew; Villanueva-Meyer, Javier; Shai, Anny; Warrier, Gayathri; Rice, Terri; Crane, Jason; Wrensch, Margaret; Wiencke, John K.; Daras, Mariza; Oberheim Bush, Nancy Ann; Taylor, Jennie W.; Butowski, Nicholas; Clarke, Jennifer; [...]
  • imprint: American Society of Clinical Oncology (ASCO), 2023
  • Published in: Journal of Clinical Oncology
  • Language: English
  • DOI: 10.1200/jco.21.02929
  • ISSN: 0732-183X; 1527-7755
  • Origination:
  • Footnote:
  • Description: <jats:sec><jats:title>PURPOSE</jats:title><jats:p> In patients with diffuse low-grade glioma (LGG), the extent of surgical tumor resection (EOR) has a controversial role, in part because a randomized clinical trial with different levels of EOR is not feasible. </jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p> In a 20-year retrospective cohort of 392 patients with IDH-mutant grade 2 glioma, we analyzed the combined effects of volumetric EOR and molecular and clinical factors on overall survival (OS) and progression-free survival by recursive partitioning analysis. The OS results were validated in two external cohorts (n = 365). Propensity score analysis of the combined cohorts (n = 757) was used to mimic a randomized clinical trial with varying levels of EOR. </jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p> Recursive partitioning analysis identified three survival risk groups. Median OS was shortest in two subsets of patients with astrocytoma: those with postoperative tumor volume (TV) &gt; 4.6 mL and those with preoperative TV &gt; 43.1 mL and postoperative TV ≤ 4.6 mL. Intermediate OS was seen in patients with astrocytoma who had chemotherapy with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL in addition to oligodendroglioma patients with either preoperative TV &gt; 43.1 mL and residual TV ≤ 4.6 mL or postoperative residual volume &gt; 4.6 mL. Longest OS was seen in astrocytoma patients with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL who received no chemotherapy and oligodendroglioma patients with preoperative TV ≤ 43.1 mL and postoperative TV ≤ 4.6 mL. EOR ≥ 75% improved survival outcomes, as shown by propensity score analysis. </jats:p></jats:sec><jats:sec><jats:title>CONCLUSION</jats:title><jats:p> Across both subtypes of LGG, EOR beginning at 75% improves OS while beginning at 80% improves progression-free survival. Nonetheless, maximal resection with preservation of neurological function remains the treatment goal. Our findings have implications for surgical strategies for LGGs, particularly oligodendroglioma. </jats:p></jats:sec><jats:sec><jats:title /><jats:p> [Media: see text] </jats:p></jats:sec>
  • Access State: Open Access