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Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system

  • Clinical Study
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Abstract

Purpose

According to the 2016 WHO classification lower-grade gliomas consist of three groups: IDH-mutated and 1p/19q co-deleted, IDH-mutated and IDH-wildtype tumors. The aim of this study was to evaluate the impact of surgical therapy for lower-grade gliomas with a particular focus on the molecular subgroups.

Methods

This is a bi-centric retrospective analysis including 299 patients, who underwent treatment for lower-grade glioma between 1990 and 2016. All tumors were re-classified according to the 2016 WHO classification. Data concerning baseline and tumor characteristics, overall survival, different treatment modalities and functional outcome were analyzed.

Results

A total of 112 (37.5%) patients with IDH-mutation and 1p/19q co-deletetion, 86 (28.8%) patients with IDH-mutation and 101 (33.8%) patients with IDH-wildtype tumors were identified. The median overall survival (mOS) differed significantly between the groups (p < 0.001). Surgical resection was performed in 226 patients and showed significantly improved mOS compared to the biopsy group (p = 0.001). Gross total resection (GTR) was associated with better survival (p = 0.007) in the whole cohort as well as in the IDH-mutated and IDH-wildtype groups compared to partial resection or biopsy. IDH-wildtype patients presented a significant survival benefit after combined radio-chemotherapy compared to radio- or chemotherapy alone (p = 0.02). Good clinical status (NANO) was associated with longer OS (p = 0.001).

Conclusion

The impact of surgical treatment on the outcome of lower-grade gliomas depends to a great extent on the molecular subtype of the tumors. Patients with more aggressive tumors (IDH-wildtype) seem to profit from more intensive treatment like GTR, multiple resections and combined radio-/chemotherapy.

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Funding

This research did not receive any financial or material support from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Neurosurgery, Medical Center, Freiburg, Germany

    Daniel Delev, Dieter Henrik Heiland, Pamela Franco & Oliver Schnell

  2. Department of Stereotactic and Functional Neurosurgery, Medical Center, Freiburg, Germany

    Peter Reinacher

  3. Department of Neuroradiology, Medical Center, Freiburg, Germany

    Irina Mader

  4. Institute of Neuropathology, Freiburg University Medical Center, Freiburg, Germany

    Ori Staszewski

  5. Institute of Pathology, University of Freiburg, Freiburg, Germany

    Silke Lassmann

  6. Department of Neurosurgery, University Hospital Cologne, Cologne, Germany

    Stefan Grau

  7. Medical Faculty, Freiburg University, Freiburg, Germany

    Daniel Delev, Dieter Henrik Heiland, Pamela Franco, Peter Reinacher, Irina Mader, Ori Staszewski, Silke Lassmann & Oliver Schnell

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  1. Daniel Delev
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Correspondence to Daniel Delev.

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Electronic supplementary material

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11060_2018_3030_MOESM1_ESM.png

Supplementary figure 1 Kaplan Meier Curves showing the overall survival according to extent of resection, comparing patients with at least one gross total resection (GTR) to those with biopsy or partial resection after molecular subgroup stratification (PNG 487 KB)

11060_2018_3030_MOESM2_ESM.png

Supplementary figure 2 Kaplan Meier Curves showing the overall survival according to WHO grade after molecular subgroup stratification (PNG 480 KB)

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Delev, D., Heiland, D.H., Franco, P. et al. Surgical management of lower-grade glioma in the spotlight of the 2016 WHO classification system. J Neurooncol 141, 223–233 (2019). https://doi.org/10.1007/s11060-018-03030-w

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  • DOI: https://doi.org/10.1007/s11060-018-03030-w

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