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Research ArticleAdult Brain

Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype

S.H. Patel, A.G. Bansal, E.B. Young, P.P. Batchala, J.T. Patrie, M.B. Lopes, R. Jain, C.E. Fadul and D. Schiff
American Journal of Neuroradiology July 2019, 40 (7) 1149-1155; DOI: https://doi.org/10.3174/ajnr.A6102
S.H. Patel
aFrom the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
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A.G. Bansal
aFrom the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
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E.B. Young
aFrom the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
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P.P. Batchala
aFrom the Departments of Radiology and Medical Imaging (S.H.P., A.G.B., E.B.Y., P.P.B.)
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J.T. Patrie
bPublic Health Sciences (J.T.P.)
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M.B. Lopes
cPathology (M.B.L.), Divisions of Neuropathology and Molecular Diagnostics
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R. Jain
eDepartments of Radiology (R.J.)
fNeurosurgery (R.J.), New York University School of Medicine, New York, New York.
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C.E. Fadul
dDivision of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
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D. Schiff
dDivision of Neuro-Oncology (C.E.F., D.S.), University of Virginia Health System, Charlottesville, Virginia
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    Fig 1.

    Glioma segmentation shown on axial FLAIR images of presurgical MR imaging (A) and postsurgical MR imaging (B) in a patient with a diffuse IDH-mutant astrocytoma who underwent subtotal resection.

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    Fig 2.

    Kaplan-Meier curves for overall patient survival based on the LGG molecular subtype. Vertical line segments along the curve identify right-censored survival times. IDHwt LGGs were associated with significantly worse overall survival compared with both IDH-mutant subtypes.

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    Fig 3.

    Kaplan-Meier curves in which overall patient survival is evaluated according to the percentage of glioma resection tertiles. Vertical line segments along the curve identify right-censored survival times. Data are shown for all patients with LGGs in the cohort (A) and separately for the 3 molecular subtypes (B–D).

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    Table 1:

    Summary of patient characteristicsa

    IDHmut-Codel (n = 68)IDHmut-Noncodel (n = 63)IDHwt (n = 41)
    Sex
        Female37 (54.4%)30 (47.6%)18 (43.9%)
        Male31 (45.6%)33 (52.4%)23 (56.1%)
    Age (yr)a45.5 (35.5–53)33 (27–42.8)57.0 (49.5–63.3)
    WHO grade
        II50 (73.5%)46 (73.0%)25 (61.0%)
        III18 (26.5%)17 (27.0%)16 (39.0%)
    Chemotherapy
        Yes55 (80.9%)53 (84.1%)30 (73.2%)
        No13 (19.1%)10 (15.9%)11 (26.8%)
    Radiation therapy
        Yes45 (66.2%)53 (84.1%)31 (75.6%)
        No23 (33.8%)10 (15.9%)10 (24.4%)
    Presurgical glioma volume (cm3)a56.4 (26.5–111.6)55.0 (31.0–116.2)47.7 (18.0–86.4)
    Postsurgical glioma volume (cm3)a28.4 (13.2–59.1)29.3 (1.2–65.6)30.1 (8.4–64.4)
    Mortality events12 (17.6%)14 (22.2%)13 (31.7%)
    • ↵a Data are listed as median and interquartile range. All other data are listed as absolute values and percentages.

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    Table 2:

    Survival analysisa

    PredictorRatioAdjusted Hazard Ratio (95% CI)P Value
    All LGGs
        Presurgical glioma volume3rd Q:1st Q1.14 (0.79–1.64).479
        Postsurgical glioma volume3rd Q:1st Q1.80 (1.18–2.75).006
        Percentage glioma resection25%:75%3.22 (1.79–5.82)<.001
    IDHmut-Codel
        Presurgical glioma volume3rd Q:1st Q1.11 (0.53–2.33).781
        Postsurgical glioma volume3rd Q:1st Q1.67 (0.82–3.48).170
        Percentage glioma resection25%:75%6.69 (1.57–28.46).010
    IDHmut-Noncodel
        Presurgical glioma volume3rd Q:1st Q3.20 (1.22–8.39).018
        Postsurgical glioma volume3rd Q:1st Q2.33 (1.32–4.12).004
        Percentage glioma resection25%:75%4.34 (1.74–10.81).002
    IDHwt
        Presurgical glioma volume3rd Q:1st Q2.18 (0.47–10.15).319
        Postsurgical glioma volume3rd Q:1st Q1.34 (0.28–4.76).653
        Percentage glioma resection25%:75%0.91 (0.29–2.82).874
    • Note:—Q indicates quartile.

    • ↵a Predictor variables for overall survival are presurgical glioma volume, postsurgical glioma volume, and percentage glioma resection. Adjusted hazard ratios are listed for the entire cohort and for the 3 molecular subtypes, with age, sex, glioma grade, and chemotherapy and radiation therapy administration as the adjustment variables.

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American Journal of Neuroradiology: 40 (7)
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S.H. Patel, A.G. Bansal, E.B. Young, P.P. Batchala, J.T. Patrie, M.B. Lopes, R. Jain, C.E. Fadul, D. Schiff
Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype
American Journal of Neuroradiology Jul 2019, 40 (7) 1149-1155; DOI: 10.3174/ajnr.A6102

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Extent of Surgical Resection in Lower-Grade Gliomas: Differential Impact Based on Molecular Subtype
S.H. Patel, A.G. Bansal, E.B. Young, P.P. Batchala, J.T. Patrie, M.B. Lopes, R. Jain, C.E. Fadul, D. Schiff
American Journal of Neuroradiology Jul 2019, 40 (7) 1149-1155; DOI: 10.3174/ajnr.A6102
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