Article
Surgical and oncological management of WHO grade III gliomas in the era of molecular-genetic markers
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Authors
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Daniel Delev
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Dieter Henrik Heiland
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Gerrit Haaker
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Pamela Franco
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
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Oliver Schnell
- Universitätsklinikum Freiburg, Klinik für Neurochirurgie, Freiburg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Diffuse lower-grade gliomas (LGGs, WHO grade II and grade III), account for 15% of all glial brain tumors in adults. Despite the impact of molecular-genetic markers introduced by the 2016 WHO-classification, histopathological and morphological features still remain important for prognostic estimation of LGGs. The aim of this study was to evaluate the impact of the surgical therapy with a particular focus on molecular-stratified WHO grade III tumors.
Methods: This is a single-center retrospective analysis including 122 patients, who underwent surgical treatment for WHO grade III tumors. All tumors were additionally re-classified according to the 2016 WHO classification. Comprehensive data concerning overall survival, progression free survival, different treatment modalities, functional outcome have been collected and analyzed.
Results: A total of 40 patients (32.8%) with IDH-mutation and 1p/19q co-deletion, 22 patients (18.0%) with IDH-mutation and 60 patients (49.2%) with IDH-wildtype tumors were identified. The median overall survival (mOS) differed significantly between the groups (p<0.001, HR=3.0, CI=2.0-4.1) Surgical resection was performed in 96 (78%) patients. The mOS in the resection group was significantly longer compared to the biopsy group (HR=0.2, CI=0.1-0.3 p=0.001). This result remained significant after molecular subgroup stratification as well. GTR was significantly associated with better survival (HR=2.2, CI=1.2-4.1, p=0.008) in the whole cohort and the IDH-WT group. Patients with more than two resections showed more favorable survival (p=0.03) in the IDH-WT group. IDH-wildtype patients presented a significant survival benefit after combined radio-chemotherapy compared to radio- or chemotherapy alone (HR=2.8, CI=1.1-7.4, p=0.03). Patients without any neurological impairment showed significantly longer mOS compared to those with neurological deficits (HR=3.5, CI=1.8-6.9, p=0.001).
Conclusion: The molecular-genetic markers (IDH mutation and 1p/19q-codeletion) determine the clinical and oncological course of WHO grade III gliomas. Surgical resection, GTR and unimpaired neurological status were found to be associated with more favorable oncological outcome. Patients with more aggressive tumors (IDH-WT) seem to profit from more aggressive surgical treatment.
