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

Clinical article

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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.


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.


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.


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.

Article Information

Address correspondence to: Edward F. Chang, M.D., Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, M779, San Francisco, California 94143. email:

© AANS, except where prohibited by US copyright law.



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    Illustration showing presumed eloquent areas for UCSF LGG score.

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    Graphs showing long-term OS (upper) and PFS (lower) in patients after resection of LGG. Cum. = Cumulative.

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    Four example applications of the UCSF LGG scoring system. A: Score 1: A T2-weighted MR image obtained in a 35-year-old man who had presented with a generalized tonicclonic seizure, revealing a discrete, well-delineated, 3.2-cm right frontal hyperintense mass, with no abnormal enhancement. B: Score 2: A T2-weighted MR image obtained in a 34-year-old woman with a 3-month history of progressively worsening numbness in her left hand, showing a diffuse, ill-defined focus of T2 prolongation in the right frontal lobe measuring 2.2 cm in maximum diameter. This lesion was considered to be in a region of eloquence because it was situated directly adjacent to and overlying the precentral gyrus (motor strip), at the expected location of the hand representation. C: Score 3: An MR image obtained in a 22-year-old woman with persistent headaches for > 2 years, demonstrating an 8.5-cm left temporal nonenhancing lesion with heterogeneous T2 prolongation and involving presumed eloquent perisylvian language areas. D: Score 4: An MR image obtained in a 59-year-old man who had presented with a history of complex partial seizures during the past 4 years, revealing T2 prolongation in the left insular region involving the medial and anterior temporal lobe, inferior frontal cortex, and basal ganglia regions and measuring 5.2 cm in maximum diameter.


  • 1

    Barker FG IIChang SMHuhn SLDavis RLGutin PHMc-Dermott MW: Age and the risk of anaplasia in magnetic resonance-nonenhancing supratentorial cerebral tumors. Cancer 80:9369411997

  • 2

    Bauman GLote KLarson DStalpers LLeighton CFisher B: Pretreatment factors predict overall survival for patients with low-grade glioma: a recursive partitioning analysis. Int J Radiat Oncol Biol Phys 45:9239291999

  • 3

    Berger MSDeliganis AVDobbins JKeles GE: The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 74:178417911994

  • 4

    Eyre HJCrowley JJTownsend JJEltringham JRMorantz RASchulman SF: A randomized trial of radiotherapy versus radiotherapy plus CCNU for incompletely resected lowgrade gliomas: a Southwest Oncology Group study. J Neurosurg 78:9099141993

  • 5

    Ganslandt OFahlbusch RNimsky CKober HMoller MSteinmeier R: Functional neuronavigation with magnetoencephalography: outcome in 50 patients with lesions around the motor cortex. Neurosurg Focus 6:3E31999

  • 6

    Hamlat ASaikali SChaperon JCarsin-Nicol BCalve MLLesimple T: Proposal of a scoring scale as a survival predictor in intracranial oligodendrogliomas. J Neurooncol 79:1591682006

  • 7

    Janny PCure HMohr MHeldt NKwiatkowski FLemaire JJ: Low grade supratentorial astrocytomas. Management and prognostic factors. Cancer 73:193719451994

  • 8

    Karim ABMaat BHatlevoll RMenten JRutten EHThomas DG: A randomized trial on dose-response in radiation therapy of low-grade cerebral glioma: European Organization for Research and Treatment of Cancer (EORTC) Study 22844. Int J Radiat Oncol Biol Phys 36:5495561996

  • 9

    Keles GELamborn KRBerger MS: Low-grade hemispheric gliomas in adults: a critical review of extent of resection as a factor influencing outcome. J Neurosurg 95:7357452001

  • 10

    Kleihues PLouis DNScheithauer BWRorke LBReifenberger GBurger PC: The WHO classification of tumors of the nervous system. J Neuropathol Exp Neurol 61:2152192002

  • 11

    Kreth FWFaist MRossner RVolk BOstertag CB: Supratentorial World Health Organization Grade 2 astrocytomas and oligoastrocytomas. A new pattern of prognostic factors. Cancer 79:3703791997

  • 12

    Laws ER JrTaylor WFClifton MBOkazaki H: Neurosurgical management of low-grade astrocytoma of the cerebral hemispheres. J Neurosurg 61:6656731984

  • 13

    Leighton CFisher BBauman GDepiero SStitt LMacDonald D: Supratentorial low-grade glioma in adults: an analysis of prognostic factors and timing of radiation. J Clin Oncol 15:129413011997

  • 14

    Lote KEgeland THager BStenwig BSkullerud KBerg-Johnsen J: Survival, prognostic factors, and therapeutic efficacy in low-grade glioma: a retrospective study in 379 patients. J Clin Oncol 15:312931401997

  • 15

    Nicolato AGerosa MAFina PIuzzolino PGiorgiutti FBricolo A: Prognostic factors in low-grade supratentorial astrocytomas: a uni-multivariate statistical analysis in 76 surgically treated adult patients. Surg Neurol 44:2082231995

  • 16

    Piepmeier JChristopher SSpencer DByrne TKim JKnisel JP: Variations in the natural history and survival of patients with supratentorial low-grade astrocytomas. Neurosurgery 38:8728791996

  • 17

    Pignatti Fvan den Bent MCurran DDebruyne CSylvester RTherasse P: Prognostic factors for survival in adult patients with cerebral low-grade glioma. J Clin Oncol 20:207620842002

  • 18

    Schiffbauer HBerger MSFerrari PFreudenstein DRowley HARoberts TP: Preoperative magnetic source imaging for brain tumor surgery: a quantitative comparison with intraoperative sensory and motor mapping. J Neurosurg 97:133313422002

  • 19

    Schiffbauer HFerrari PRowley HABerger MSRoberts TP: Functional activity within brain tumors: a magnetic source imaging study. Neurosurgery 49:131313212001

  • 20

    Shaw EArusell RScheithauer BO'Fallon JO'Neill BDinapoli R: Prospective randomized trial of low- versus high-dose radiation therapy in adults with supratentorial lowgrade glioma: initial report of a North Central Cancer Treatment Group/Radiation Therapy Oncology Group/Eastern Cooperative Oncology Group study. J Clin Oncol 20:226722762002

  • 21

    Shaw EGDaumas-Duport CScheithauer BWGilbertson DTO'Fallon JREarle JD: Radiation therapy in the management of low-grade supratentorial astrocytomas. J Neurosurg 70:8538611989

  • 22

    Smith JSPerry ABorell TJLee HKO'Fallon JHosek SM: Alterations of chromosome arms 1p and 19q as predictors of survival in oligodendrogliomas, astrocytomas, and mixed oligoastrocytomas. J Clin Oncol 18:6366452000

  • 23

    van den Bent MJAfra Dde Witte OBen Hassel MSchraub SHoang-Xuan K: Long-term efficacy of early versus delayed radiotherapy for low-grade astrocytoma and oligodendroglioma in adults: the EORTC 22845 randomised trial. Lancet 366:9859902005


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