Preoperative prognostic classification system for hemispheric low-grade gliomas in adults. J Neurosurg

Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California 94143, USA.
Journal of Neurosurgery (Impact Factor: 3.74). 11/2008; 109(5):817-24. DOI: 10.3171/JNS/2008/109/11/0817
Source: PubMed

ABSTRACT Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs.
The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system.
The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71-10.42), Karnofsky Performance Scale score < or = 80 (HR 3.53, 95% CI 1.56-8.00), patient age > 50 years (HR 1.96, 95% CI 1.47-3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43-8.06). A scoring system calculated from the sum of these factors (range 0-4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0-1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3-4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described.
The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.

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Available from: Michael Prados, Nov 18, 2014
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    • "Ces chiffres sont nettement plus faibles pour les tumeurs dites malignes : 50 % pour les gliomes anaplasiques (grade 3 OMS), 25 à 60 % pour les glioblastomes (grade 4 OMS), 20 à 35 % pour les métastases cérébrales et 10 % pour les lymphomes primitifs du système nerveux central. Parmi les facteurs liés aux interactions entre l'infiltration tumorale et le tissu cérébral, l'existence d'un envahissement cortical d'origine tumorale est associé au risque épileptique [4,7,9,16– 22] aussi bien dans les gliomes infiltrants de bas grade [22] [23] que dans ceux de haut grade de malignité [24]. À l'inverse, les tumeurs profondes ont un risque moindre d'épilepsie [25]. "
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    ABSTRACT: Les tumeurs cérébrales et l’épilepsie entretiennent des relations privilégiées : les tumeurs sont fréquemment cause de crises épileptiques, avec une variabilité selon le type tumoral, et les causes tumorales ne sont pas rares dans les épilepsies de l’adulte. Si la crise épileptique est un mode habituel de découverte de la tumeur, leur récurrence voire leur pharmaco-résistance peuvent représenter un trouble spécifique associé à la maladie oncologique. La maladie épileptique évolue par ailleurs au cours de la maladie tumorale. La prise en charge de l’épilepsie tumorale présente certaines spécificités du fait d’interactions avec les traitements oncologiques. Seront ici décrits : les liens épidémiologiques entre tumeurs cérébrales et épilepsie, les caractéristiques cliniques des crises, le mode de prise en charge diagnostique, les principes et règles de la prise en charge médicamenteuse antiépileptique et les effets du traitement oncologique sur l’épilepsie.
    Pratique Neurologique - FMC 02/2015; 6(1). DOI:10.1016/j.praneu.2014.12.010
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    • "One study has described pre-operative tumor size and tumor histology types prognostic of PFS after surgery in patients with low grade gliomas under 40 years’ old.1 Another study showes that patients with age over 50 years, low Karnofsky performance status (KPS) and larger tumor size had unfavorable prognosis of overall survival after surgery in low grade gliomas.2 But no literature has described factors predictive of PFS after initial surgery in patients with astrocytomas of low and high tumor grades. "
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    ABSTRACT: Objective: Pre-operative predictive factors of progression-free survival (PFS) and tumor recurrence after initial surgery are important in counseling patients and decision making. Though PFS after initial surgery in patients with low grade astrocytomas has been described, little is described about PFS in patients with different tumor grades. Our objective was to investigate potential predictive factors of PFS, and devise a scale to predict PFS and tumor recurrence after initial surgery in patients with primary and recurrent astrocytomas of low and high tumor grades. Methods: Clinical, radiographic, pathological and treatment data of 62 patients whose initial treatments of primary and recurrent astrocytomas were both surgeries were analyzed, and factors that had significant correlation with PFS was used to devise a scale. Results: Factors significantly related with PFS were: the time from onset of symptoms to clinical and radiological diagnosis of astrocytomas (Spearman correlation coefficient r=0.298, significance level P=0.019) and with the symptoms of seizures (r=0.292, P=0.021). Patients with age between 30 and 40 years had significant longer PFS than the rest age group (P=0.018, oneway ANOVA). A simple scale (from 0 to 3 points) comprised of the three factors distinguished four groups of patients with significant different post-operative PFS (0 point, 8.0 months; 1 point, 13.7 months; 2 points, 18.0 months; 3 points, 34.5 months) (P=0.004, oneway ANOVA). Conclusion: The simple scale we devised comprised of the three pre-operative prognostic factors can significantly distinguish patients with different post-operative survival after initial treatment of astrocytomas with surgery.
    Pakistan Journal of Medical Sciences Online 02/2014; 30(1):136-9. DOI:10.12669/pjms.301.4110 · 0.23 Impact Factor
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    • "The focus of the present paper was to determine which factors in EATs could be predictive of the EOR and functional outcome. Traditionally, surgical series have analyzed outcomes based on the anatomical location of the tumor (non-eloquent, near-eloquent, or eloquent), with the eloquent location being an intrinsic negative factor for the EOR and postoperative functional status [20], [22], [24], [25]. Intuitively, the prediction of both the EOR and functional outcome is particularly hard to obtain even with the help of modern neuroradiologic advancements such as fMRI and DTI-ft. "
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    ABSTRACT: To date, few parameters have been found that can aid in patient selection and surgical strategy for eloquent area gliomas. The aim of the study was to analyze preoperative and intraoperative factors that can predict functional outcome and extent of resection in eloquent area tumors. A retrospective analysis was conducted on 60 patients harboring supratentorial gliomas in eloquent areas undergoing awake surgery. The analysis considered clinical, neuroradiologic (morphologic), intraoperative, and postoperative factors. End-points were extent of resection (EOR) as well as functional short- and long-term outcome. Postoperatively, MRI objectively established the EOR. χ(2) analyses were used to evaluate parameters that could be predictive. Multivariate logistic regression analyses were used to evaluate the best combination to predict binary positive outcomes. In 90% of the cases, subcortical stimulation was positive in the margins of the surgical cavity. Postoperatively, 51% of the patients deteriorated but 90% of the patients regained their preoperative neurological score. Factors negatively affecting EOR were volume, degree of subcortical infiltration, and presence of paresis (P<0.01). Sharp margins and cystic components were more amenable to gross total resection (P<0.01). Contrast enhancement (P<0.02), higher grade (P<0.01), paresis (P<0.01), and residual tumor in the cortex (P<0.02) negatively affected long-term functional outcomes, whereas postoperative deterioration could not be predicted for any factor other than paresis. Subcortical stimulation did not correlate with deterioration, both postoperatively (P<0.08) and at follow-up (P<0.042). Biological and morphological factors such as type of margins, volume, preoperative neurological status, cystic components, histology and the type of infiltration into the white matter must be considered when planning intraoperative mapping.
    PLoS ONE 12/2013; 8(12):e80916. DOI:10.1371/journal.pone.0080916 · 3.23 Impact Factor
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