gms | German Medical Science

Objective: According to unremitting research in recent years, different groups of prognostic factors – molecular features, tumor volumes and epidemiological data – have been proposed for outcome evaluation in patients with lower-grade gliomas. We compared the integrative impact of these factors in terms of overall survival.

Methods: All consecutive patients with diffuse (WHO °II) or anaplastic glioma (WHO °III), who underwent surgery between 2010 and 2019, were included. The pre- and postoperative MRI volumes in T1 CE, T2 and diffused weighted imaging were measured. IDH, ATRX and EGFR status was assessed during neuropathological routine examination or using FFPE tissue from our biobank. Clinical and follow-up data were gained from the institutional neurooncological database.

Results: 202 patients (115 men, 87 women) with a median age of 47 years (IqR 36 – 57) were included. Advanced WHO grade (HR 9.0, CI95% 2.3 – 34.2), IDH wild-type (HR 2.1, CI95% 1.0 – 4.4), preoperative (HR 1.028/cc, CI95% 1.004 – 1.052) and postoperative T1 CE volume (HR 1.209/cc, CI95% 1.063 – 1.375), as well as postoperative T2 positive remnant tumor and oedema volume (HR 1.013/cc, CI95% 1.003 – 1.023) showed a significant influence on OS in multivariate Cox analysis.

The OS was decreased in case of anaplasia: 100 months (CI95% 91 – 108) vs. 50 (CI95% 39 – 61), as well as IDH wild-type: 55 months (CI95% 44 – 71) vs. 94 (CI95% 85 – 103). Gliomas with preoperative CE showed an OS of 57 months (CI95% 47 – 67) versus 98 (CI95% 88 – 107) in those without CE. Similar results could be shown for postoperative CE with 90 (CI95% 81 – 98) vs. 46 (CI95% 28 – 64) months correspondingly.

Conclusion: The prognosis for patients with diffuse and anaplastic glioma should be based on integrative evaluation of neuropathological and radiological parameters. Despite the increasing importance of molecular features, the value of WHO grade and contrast enhancement for the OS should not be underestimated.