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Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping

  • Clinical Study
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Abstract

Purpose

The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping.

Methods

We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020.

Results

EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of ≥ 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR ≥ 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7–48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR ≥ 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9–51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3–59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas.

Conclusions

The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was ≥ 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.

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Availability of data and materials (data transparency)

The data in the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors thank Mr. Hiroyasu Yamamoto, Mr. Kyohei Koyama, Mr. Daisuke Hara, and Mr. Yasuyuki Matsui (Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan) for their technical assistance.

Funding

This work was supported by a Grant-in-Aid for Scientific Research (C) awarded to K.M. (No. 17K10862) from the Japan Society for the Promotion of Science (JSPS). We have no financial disclosures or conflicts of interest to declare.

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Authors and Affiliations

  1. Department of Neurosurgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Kazuya Motomura, Lushun Chalise, Fumiharu Ohka, Kosuke Aoki, Kuniaki Tanahashi, Masaki Hirano, Tomohide Nishikawa, Junya Yamaguchi, Hiroyuki Shimizu, Toshihiko Wakabayashi & Ryuta Saito

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Contributions

Experimental design: KM, TW, RS. Collection and assembly of data: LC, KT, MH, TN. JY, HS. Analysis and interpretation of the data: KM, FO, KA, RS. Manuscript writing: KM. Final approval of manuscript: all authors.

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Correspondence to Kazuya Motomura.

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Patient informed consents were waived due to the retrospective nature of the study.

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The Ethics Committee at Nagoya University Hospital approved this retrospective data evaluation and the experimental design of the study (approval number: 2020-0079).

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Motomura, K., Chalise, L., Ohka, F. et al. Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping. J Neurooncol 153, 361–372 (2021). https://doi.org/10.1007/s11060-021-03776-w

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