Spontaneous and therapeutic prognostic factors in adult hemispheric World Health Organization Grade II gliomas: a series of 1097 cases

Clinical article

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  • 1 Departments of Neurosurgery,
  • 5 Biostatistics,
  • 10 Neuropathology,
  • 12 Neuroradiology, and
  • 14 Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris;
  • 2 Departments of Neurosurgery and
  • 17 Neuropathology, Centre Hospitalier Universitaire de Nice;
  • 3 Department of Neurosurgery, Hôpital Lariboisière, Paris;
  • 4 Departments of Neurology and
  • 18 Neurosurgery, Centre Hospitalier Universitaire de Nancy;
  • 6 Departments of Neurosurgery and
  • 16 Neuropathology, Centre Hospitalier Universitaire de Montpellier;
  • 7 Department of Neurosurgery, Centre Hospitalier Sainte-Anne, Paris;
  • 8 Department of Neurosurgery, Centre Hospitalier Universitaire de Reims;
  • 9 Department of Radiotherapy, Centre Hospitalier Universitaire de Besançon;
  • 11 Department of Neurosurgery, Centre Hospitalier Universitaire de Lyon;
  • 13 Centre Anti-Cancéreux Antoine Lacassagne, Nice; and
  • 15 Polyclinique Courlancy, Reims, France
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Object

The spontaneous prognostic factors and optimal therapeutic strategy for WHO Grade II gliomas (GIIGs) have yet to be unanimously defined. Specifically, the role of resection is still debated, most notably because the actual amount of resection has seldom been assessed.

Methods

Cases of GIIGs treated before December 2007 were extracted from a multicenter database retrospectively collected since January 1985 and prospectively collected since 1996. Inclusion criteria were a patient age ≥ 18 years at diagnosis, histological diagnosis of WHO GIIG, and MRI evaluation of tumor volume at diagnosis and after initial surgery. One thousand ninety-seven lesions were included in the analysis. The mean follow-up was 7.4 years since radiological diagnosis. Factors significant in a univariate analysis (with a p value ≤ 0.1) were included in the multivariate Cox proportional hazard regression model analysis.

Results

At the time of radiological diagnosis, independent spontaneous factors of a poor prognosis were an age ≥ 55 years, an impaired functional status, a tumor location in a nonfrontal area, and, most of all, a larger tumor size. When the study starting point was set at the time of first treatment, independent favorable prognostic factors were limited to a smaller tumor size, an epileptic symptomatology, and a greater extent of resection.

Conclusions

This large series with its volumetric assessment refines the prognostic value of previously stressed clinical and radiological parameters and highlights the importance of tumor size and location. The results support additional arguments in favor of the predominant role of resection, in accordance with recently reported experiences.

Abbreviations used in this paper:DICOM = Digital Imaging and Communications in Medicine; EORTC = European Organisation for Research and Treatment of Cancer; GII = WHO Grade II; GIIG = Grade II glioma; KPS = Karnofsky Performance Scale.

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Contributor Notes

Address correspondence to: Laurent Capelle, M.D., Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75634 Paris Cedex 13, France. email: laurent.capelle@psl.ap-hop-paris.fr.

Please include this information when citing this paper: published online March 15, 2013; DOI: 10.3171/2013.1.JNS121.

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