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

Clinical article

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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.

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: ChangEd@neurosurg.ucsf.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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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.

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