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

• Motomura, Kazuya

• Chalise, Lushun

• Ohka, Fumiharu

• Aoki, Kosuke

• Tanahashi, Kuniaki

• Hirano, Masaki

• Nishikawa, Tomohide

• Yamaguchi, Junya

• Shimizu, Hiroyuki

• Wakabayashi, Toshihiko

• Saito, Ryuta

抄録

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.

収録刊行物

• Journal of Neuro-Oncology

  Journal of Neuro-Oncology 153 (2), 361-372, 2021-06

  Springer

キーワード

• Cancer Research
• Neurology (clinical)
• Neurology
• Oncology

詳細情報

• CRID: 1050290537401840384
• NII論文ID: 120007180217
• DOI: 10.1007/s11060-021-03776-w
• ISSN: 15737373
• ISSN: 0167594X
• HANDLE: 2237/0002001767
• Web Site: https://nagoya.repo.nii.ac.jp/records/2001767
• Web Site: https://link.springer.com/content/pdf/10.1007/s11060-021-03776-w.pdf
• Web Site: https://link.springer.com/article/10.1007/s11060-021-03776-w/fulltext.html
• 本文言語コード: en
• 資料種別: journal article
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