Artikel
Continuous volmetric impact of surgery on survival in low-grade gliomas – a retrospective multicentre assessment from the German study-group for intraoperative MRI
Kontinuierlicher volumetrischer Effekt auf das Überleben nach Resektion von Low-Grade Gliomen – eine retrospektive Multicenter-Analyse der German Study-Group for Intraoperative MRI
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Autoren
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Moritz Scherer
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Hajrullah Ahmeti
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
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Constantin Roder
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Florian Geßler
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Christian Senft
- Universitätsklinikum Frankfurt, Neurochirurgie, Frankfurt am Main, Deutschland
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Marcos Tatagiba
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Michael Synowitz
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Neurochirurgie, Kiel, Deutschland
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Christian Rainer Wirtz
- Universitätsklinikum Ulm/Günzburg, Neurochirurgie, Ulm/Günzburg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Jan Coburger
- Universitätsklinikum Ulm/Günzburg, Neurochirurgie, Ulm/Günzburg, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
Text
Objective: The beneficial role of a surgical resection is well established in contemporary treatment for low-grade gliomas (LGG). However, LGG resections are often limited by functional boundaries and the extent of resection (EOR) required to achieve a significant survival benefit remains elusive. The aim of this study was to evaluate the influence of intraoperative (i)MRI-guided surgery on survival in LGG with a particular focus on the impact of small residual tumor volumes (RV).
Methods: Consecutive cases with iMRI-guided resections of supratentorial LGGs were retrospectively assessed among 5 centers. Only cases with known IDH status were included. Tumors were volumetrically quantified before and after surgery. Kaplan-Meier estimates and multivariate Cox regression models including clinical and molecular parameters were calculated to identify determinants of survival and to evaluate the impact of quantitative measures.
Results: From 288 cases originally identified, a total of 140 cases with available molecular information entered this volumetric analysis [astrocytomas: 92(66%), oligodendrogliomas: 48(34%), IDH mutations 128(91%)]. Median follow-up was 48months (range 2–144m). Complete tumor resection (GTR) was associated with significantly longer PFS compared to any incomplete resection (p=0.009). A significant survival disadvantage was evident even for small (>0–5ml) RV, which increased for moderate (>5–20ml) and large remnants (>20ml) (p=0.001). This implicated a linear association of RV and PFS. Accordingly, PFS increased continuously for 20% incremental steps of EOR (p<0.0001). Multivariate cox-regression models confirmed EOR (HR=0.99, 95%C.I.=0.98–0.99, p=0.003), RV (HR=1.00002, 95%C.I.=1.00001–1.00003, p=0.002) and age <40y (HR=1.78 95%C.I.=1.12–2.83, p=0.015) as independent prognosticators of PFS. Histology did not correlate with PFS in this series of iMRI-guided surgeries. IDH mutations were significantly associated with longer overall survival (HR=0.18 95%C.I=0.05–0.59, p=0.005).
Conclusion: Our data supports the hypothesis of a continuous relationship of EOR and RV with PFS. We observed the strongest benefit on survival after GTR compared to any incompletely resected LGG. Consequently, GTR should be achieved whenever safely feasible in LGG surgery and resections should be maximized whenever tumor has to be left behind to spare function. Longer follow-up is required to resolve possible associations between histology and EOR with regards their impact on survival.
