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Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature—a systematic review of the literature

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Abstract

There is a lack of class I evidence concerning the impact of surgery in the treatment of diffuse low-grade glioma; the early maximal resection with preservation of eloquent brain areas has been accepted as the first therapeutic option. We performed a systematic review of the literature using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and protocol. Inclusion criteria: only case series with at least 100 patients containing supratentorial hemispheric diffuse low-grade glioma (according to any of the WHO classification used in papers published between 2000 to 2019), with pre- and postoperative MRI study were included in the qualitative and quantitative analyses. The extent of resection should be defined based on MRI at least in two categories and correlated with patients’ outcomes (with univariate or multivariate analyses) using overall survival (OS) or malignant progression-free survival (MPFS). A total of 18 series with 4386 patients, published in 20 papers, were included in this systematic review. All the series that evaluates the relation between the extent of resection (EOR) and OS showed a statistically significant improvement of OS at univariate and/or multivariate analyzes with a greater EOR. Six studies showed a statistically significant improvement of MPFS with a greater EOR. We demonstrate that when a more rigorous analysis of EOR is performed, a benefit of a more aggressive resection on OS and MPFS is observed. Our review about EOR in different molecular groups of DLGG also suggests a benefit of maximum safe resection for all different subtypes, even though “radical surgery” may be associated with better OS and MPFS in tumors with a more aggressive signature.

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Authors and Affiliations

  1. Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Ceará, Brazil

    Lucas Alverne F. Albuquerque

  2. Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil

    Lucas Alverne F. Albuquerque & Andrei F. Joaquim

  3. Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    João Paulo Almeida

  4. Health Science Center, University of Fortaleza, Fortaleza, Ceará, Brazil

    Leonardo José Monteiro de Macêdo Filho

  5. Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France

    Hugues Duffau

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  1. Lucas Alverne F. Albuquerque
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Contributions

LAFA: Conceptualization, methodology, investigation, resources, writing—original draft, writing—review and editing, supervision, project administration. JPA: conceptualization, investigation, resources, writing—original draft, writing—review and editing, supervision. LJMMF: methodology, resources, writing—original draft, writing—review and editing. AFJ: writing—original draft, writing—review and editing, supervision. HD: writing—original draft, writing—review and editing, supervision.

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Correspondence to Lucas Alverne F. Albuquerque.

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Key points

- When systematically measured, the importance of EOR for DLGG is evident in outcome.

- All subgroups of DLGG benefit from a higher EOR.

- Higher EOR may have a greater impact on DLGG with a more aggressive signature.

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Albuquerque, L.A.F., Almeida, J.P., de Macêdo Filho, L.J.M. et al. Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature—a systematic review of the literature. Neurosurg Rev 44, 1371–1389 (2021). https://doi.org/10.1007/s10143-020-01362-8

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