Preoperative prognostic classification system for hemispheric low-grade gliomas in adults

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Edward F. Chang Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Justin S. Smith Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Susan M. Chang Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Kathleen R. Lamborn Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Michael D. Prados Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Nicholas Butowski Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Nicholas M. Barbaro Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Andrew T. Parsa Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Mitchel S. Berger Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Michael M. Mcdermott Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California

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Object

Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs.

Methods

The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system.

Results

The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71–10.42), Karnofsky Performance Scale score ≤ 80 (HR 3.53, 95% CI 1.56–8.00), patient age > 50 years (HR 1.96, 95% CI 1.47–3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43–8.06). A scoring system calculated from the sum of these factors (range 0–4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0–1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3–4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described.

Conclusions

The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.

Abbreviations used in this paper:

CI = confidence interval; EORTC = European Organization for Research and Treatment of Cancer; GTR = gross-total resection; HR = hazard ratio; KPS = Karnofsky Performance Scale; LGG = low-grade glioma; OR = odds ratio; OS = overall survival; PFS = progression-free survival; STR = subtotal resection; UCSF = University of California, San Francisco.
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