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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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.

Article Information

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.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Graphs demonstrating overall survival. A: Survival since radiological diagnosis (1097 cases). B: Survival since first treatment (929 cases). C: Anaplastic transformation since radiological diagnosis (1097 cases). The x axes represent the duration of follow-up in months; the y axes, the percentage of patients (1 = 100%).

  • View in gallery

    Graph showing survival since radiological diagnosis, according to age. The x axis represents the time since radiological diagnosis; the y axis, the percentage of patients (1 = 100%).

  • View in gallery

    Graph showing survival since radiological diagnosis, according to initial tumor volume. Tumor volume is expressed as the mean tumor diameter (D). The mean tumor diameters of 20, 40, and 60 mm are equivalent to tumor volumes of 4, 32, and 108 cm3, respectively. The x axis represents the time since radiological diagnosis; the y axis, the percentage of patients (1 = 100%).

  • View in gallery

    Graph showing survival since radiological diagnosis, according to tumor location. The x axis represents the time since radiological diagnosis; the y axis, the percentage of patients (1 = 100%).

  • View in gallery

    Graphs showing postoperative survival, according to extent of resection (929 cases, including those with only biopsy). Upper: Survival according to percentage of tumor resection. Lower: Survival according to volume of residual tumor. The x axes represent the duration of follow-up in months; the y axes, the percentage of patients (1 = 100%).

  • View in gallery

    Graphs showing survival since first treatment according to 3 prognostic scores. A: Survival according to the Bauman scoring system.6 B: Survival according to the Pignatti scoring system.51 C: Survival according to the Chang scoring system.14 The x axes represent the duration of follow-up in months; the y axes, the percentage of patients (1 = 100%).

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