Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas

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  • 1 Department of Neurological Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medical Center;
  • 2 Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York;
  • 3 Department of Neurological Surgery, Oregon Health & Sciences University, Portland, Oregon;
  • 4 Department of Neurology, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center;
  • 5 Department of Radiation Oncology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center;
  • 6 Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center;
  • 7 Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center;
  • 8 Departments of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center;
  • 9 Department of Epidemiology, Mailman School of Public Health, and Department of Medicine, Vagelos College of Physicians and Surgeons, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York; and
  • 10 Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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OBJECTIVE

Genomic analysis in neurooncology has underscored the importance of understanding the patterns of survival in different molecular subtypes within gliomas and their responses to treatment. In particular, diffuse gliomas are now principally characterized by their mutation status (IDH1 and 1p/19q codeletion), yet there remains a paucity of information regarding the prognostic value of molecular markers and extent of resection (EOR) on survival. Furthermore, given the modern emphasis on molecular rather than histological diagnosis, it is important to examine the effect of maximal resection on survival in all gliomas with 1p/q19 codeletions, as these will now be classified as oligodendrogliomas under the new WHO guidelines.

The objectives of the present study were twofold: 1) to assess the association between EOR and survival for patients with oligodendrogliomas in the National Cancer Database (NCDB), which includes information on mutation status, and 2) to demonstrate the same effect for all patients with 1p/19q codeleted gliomas in the NCDB.

METHODS

The NCDB was queried for all cases of oligodendroglioma between 2004 and 2014, with follow-up dates through 2016. The authors found 2514 cases of histologically confirmed oligodendrogliomas for the final analysis of the effect of EOR on survival. Upon further query, 1067 1p/19q-codeleted tumors were identified in the NCDB. Patients who received subtotal resection (STR) or gross-total resection (GTR) were compared to those who received no tumor debulking surgery. Univariable and multivariable analyses of both overall survival and cause-specific survival were performed.

RESULTS

EOR was associated with increased overall survival for both histologically confirmed oligodendrogliomas and all 1p/19q-codeleted–defined tumors (p < 0.001 and p = 0.002, respectively). Tumor grade, location, and size covaried predictably with EOR. When evaluating tumors by each classification system for predictors of overall survival, facility setting, age, comorbidity index, grade, location, chemotherapy, and radiation therapy were all shown to be significantly associated with overall survival. While STR and GTR correlated with a stepwise increase in survival in oligodendrogliomas relative to biopsy (HR 0.70, p < 0.01; HR 0.51, p < 0.001, respectively), only GTR was observed to have the same effect in patients with 1p/19q-codeleted–defined tumors (HR 0.49, p = 0.002).

CONCLUSIONS

By using the NCDB, the authors have demonstrated a side-by-side comparison of the survival benefits of greater EOR in 1p/19q-codeleted gliomas.

ABBREVIATIONS CSS = cause-specific survival; EOR = extent of resection; GTR = gross-total resection; HGG = high-grade glioma; ICD = International Classification of Diseases; IDH = isocitrate dehydrogenase; LGG = low-grade glioma; NCDB = National Cancer Database; OS = overall survival; O2 = grade II oligodendroglioma; O3 = grade III oligodendroglioma; SEER = Surveillance, Epidemiology, and End Results; STR = subtotal resection; 75ST = 75% survival time.

Supplementary Materials

    • Supplemental Tables and Figure (PDF 410 KB)

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Contributor Notes

Correspondence Tony J. C. Wang: Columbia University Irving Medical Center, New York, NY. tjw2117@cumc.columbia.edu.

INCLUDE WHEN CITING Published online May 8, 2020; DOI: 10.3171/2020.2.JNS192767.

A.L.A.G. and C.J.K. contributed equally to this work and share first authorship.

Disclosures No outside funding was received to support this work. Dr. Wang reports personal fees and non-financial support from AbbVie, personal fees from AstraZeneca, personal fees from Cancer Panels, personal fees from Doximity, personal fees and non-financial support from Elekta, personal fees and non-financial support from Merck, personal fees and nonfinancial support from Novocure, personal fees and non-financial support from RTOG Foundation, personal fees from Rutgers, personal fees from University of Iowa, personal fees from Wolters Kluwer, outside the submitted work. Drs. Cheng and Sonabend report personal fees and nonfinancial support from AbbVie.

The NCDB is a joint project of the Commission on Cancer of the American College of Surgeons and the American Cancer Society.

The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology employed, or the conclusions drawn from these data, by the investigator.

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