Molecular subtype impacts surgical resection in low-grade gliomas: A Chinese Glioma Genome Atlas database analysis
Ziming Hou1, Kenan Zhang1, Xing Liu1
1Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Abstract:
Surgeons have considered extending the resection margins for better outcomes in gliomas, but have not considered molecular pathology. We investigated the impact of molecular pathology on the surgical benefit in gliomas. Herein, we collected the clinical and pathological information of 449 patients with glioma from the Chinese Glioma Genome Atlas database, and enrolled those who underwent surgical resection. We measured the impact of the extent of resection on survival time in subgroups classified by clinical characteristics. We found that gross total resection (GTR) was associated with longer survival times in the entire cohort, and each of the three molecular subtypes. Even after age stratification, there was no survival benefit from GTR in those with a Karnofsky performance score (KPS) ≤ 80. In patients aged >45 years with a KPS >80, extensive resection resulted in longer survival times in isocitrate dehydrogenase-mutated astrocytomas. Additionally, GTR was associated with longer overall survival times in patients aged ≤45 years with a KPS >80. In conclusion, extensive resection does not always prolong survival in patients with glioma. Along with clinical characteristics, molecular pathology positively impacts survival in gliomas. Neurosurgeons may consider our findings when planning surgery in the future.
Insights
Extensive glioma resection benefits survival, but molecular pathology and patient factors like Karnofsky performance score (KPS) significantly influence outcomes. Personalized surgical strategies considering these factors are crucial for improved glioma patient survival.
Area of Science:
- Neurosurgery
- Molecular Pathology
- Oncology
Background:
- Surgical resection extent is a key factor in glioma treatment.
- The role of molecular pathology in guiding surgical decisions for gliomas remains under-explored.
Purpose of the Study:
- To investigate the impact of molecular pathology on the surgical benefit in glioma patients.
- To determine if gross total resection (GTR) improves survival across different glioma molecular subtypes and clinical characteristics.
Main Methods:
- Retrospective analysis of 449 glioma patients from the Chinese Glioma Genome Atlas database.
- Evaluation of the impact of GTR on survival stratified by age, Karnofsky performance score (KPS), and molecular subtypes.
Main Results:
- GTR correlated with longer survival in the overall cohort and across molecular subtypes.
- No survival benefit from GTR was observed in patients with KPS ≤80.
- In patients >45 years with KPS >80, extensive resection improved survival in isocitrate dehydrogenase-mutated astrocytomas.
- GTR improved overall survival in patients ≤45 years with KPS >80.
Conclusions:
- Extensive glioma resection does not universally prolong survival.
- Molecular pathology and clinical characteristics significantly impact survival outcomes.
- Findings suggest personalized surgical planning for gliomas based on molecular and clinical profiles.
