The role of extent of resection in IDH1 wild-type or mutant low-grade gliomas Journal Article


Authors: Patel, T.; Bander, E. D.; Venn, R. A.; Powell, T.; Cederquist, G. Y. M.; Schaefer, P. M.; Puchi, L. A.; Akhmerov, A.; Ogilvie, S.; Reiner, A. S.; Moussazadeh, N.; Tabar, V.
Article Title: The role of extent of resection in IDH1 wild-type or mutant low-grade gliomas
Abstract: BACKGROUND: Maximizing extent of resection (EOR) improves outcomes in adults with World Health Organization (WHO) grade II low-grade gliomas (LGG). However, recent studies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1) gene are a distinct molecular and clinical entity. It remains unclear whether maximizing EOR confers an equivalent clinical benefit in IDH mutated (mtIDH) and IDH wild-type (wtIDH) LGGs. OBJECTIVE: To assess the impact of EOR on malignant progression-free survival (MPFS) and overall survival (OS) in mtIDH and wtIDH LGGs. METHODS: We performed a retrospective review of 74 patients with WHO grade II gliomas and known IDH mutational status undergoing resection at a single institution. EOR was assessed with quantitative 3-dimensional volumetric analysis. The effect of predictor variables on MPFS and OS was analyzed with Cox regression models and the Kaplan-Meier method. RESULTS: Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included. Median preoperative tumor volume was 37.4 cm(3); median EOR of 57.6% was achieved. Univariate Cox regression analysis confirmed EOR as a prognostic factor for the entire cohort. However, stratifying by IDH status demonstrates that greater EOR independently prolonged MPFS and OS for wtIDH patients (hazard ratio [HR]=0.002 [95% confidence interval {CI} 0.000-0.074] and HR=0.001 [95% CI 0.00-0.108], respectively), but not for mtIDH patients (HR=0.84 [95% CI 0.17-4.13] and HR=2.99 [95% CI 0.15-61.66], respectively). CONCLUSION: Increasing EOR confers oncologic and survival benefits in IDH1 wtLGGs, but the impact on IDH1 mtLGGs requires further study.
Keywords: clinical article; mutation; surgery; surgical resection; long-term survival; mutations; impact; idh1; natural-history; magnetic-resonance-spectroscopy; low-grade glioma; ii gliomas; extent of resection; who grade ii glioma; eloquent areas
Journal Title: Neurosurgery
Volume: 82
Issue: 6
ISSN: 0148-396X
Publisher: Oxford University Press  
Date Published: 2018-06-01
Start Page: 808
End Page: 814
Language: English
ACCESSION: WOS:000439697700018
DOI: 10.1093/neuros/nyx265
PROVIDER: wos
PUBMED: 28945860
Notes: Article -- Source: Wos
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MSK Authors
  1. Anne S Reiner
    142 Reiner
  2. Viviane S Tabar
    144 Tabar
  3. Evan Bander
    4 Bander
  4. Shahiba Q Ogilvie
    20 Ogilvie
  5. Rachael Venn
    2 Venn
  6. Luis Puchi
    2 Puchi
  7. Tiffany LaSonya Powell
    1 Powell