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

Toral Patel, Evan D. Bander, Rachael A. Venn, Tiffany Powell, Gustav Young Min Cederquist, Peter M. Schaefer, Luis A. Puchi, Akbarshakh Akhmerov, Shahiba Ogilvie, Anne S. Reiner, Nelson Moussazadeh, Viviane Tabar

Research output: Contribution to journalReview article

13 Scopus citations

Abstract

BACKGROUND: Maximizing extent of resection (EOR) improves outcomes in adults withWorld Health Organization (WHO) grade II low-grade gliomas (LGG). However, recentstudies demonstrate that LGGs bearing a mutation in the isocitrate dehydrogenase 1 (IDH1)gene are a distinct molecular and clinical entity. It remains unclear whether maximizingEOR confers an equivalent clinical beneft 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 gliomasand known IDH mutational status undergoing resection at a single institution. EOR wasassessed with quantitative 3-dimensional volumetric analysis. The effect of predictorvariables on MPFS and OS was analyzed with Cox regression models and the Kaplan-Meiermethod.RESULTS: Fifty-two (70%) mtIDH patients and 22 (30%) wtIDH patients were included.Median preoperative tumor volume was 37.4 cm3; median EOR of 57.6% was achieved.Univariate Cox regression analysis confrmed EOR as a prognostic factor for the entirecohort. However, stratifying by IDH status demonstrates that greater EOR independentlyprolonged MPFS and OS for wtIDH patients (hazard ratio [HR] = 0.002 [95% confdenceinterval {CI} 0.000-0.074] and HR = 0.001 [95% CI 0.00-0.108], respectively), but not for mtIDHpatients (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 benefts in IDH1 wtLGGs, butthe impact on IDH1 mtLGGs requires further study.

Original languageEnglish (US)
Pages (from-to)808-814
Number of pages7
JournalNeurosurgery
Volume82
Issue number6
DOIs
StatePublished - 2018

Keywords

  • Extent of resection
  • IDH1 mutation
  • Low-grade glioma
  • WHO grade II glioma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    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. (2018). The role of extent of resection in IDH1 wild-type or mutant low-grade gliomas. Neurosurgery, 82(6), 808-814. https://doi.org/10.1093/neuros/nyx265