Molecular subtype impacts surgical resection in low-grade gliomas: A Chinese Glioma Genome Atlas database analysis

• Published in: Cancer letters 2021-12, Vol.522, p.14-21
• Main Authors: Hou, Ziming, Zhang, Kenan, Liu, Xing, Fang, Shengyu, Li, Lianwang, Wang, Yinyan, Jiang, Tao
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Astrocytoma; Astrocytoma - genetics; Astrocytoma - pathology; Astrocytoma - surgery; Brain cancer; China - epidemiology; Chinese glioma genome atlas; Classification; Disease-Free Survival; Extent of resection; Female; Genomes; Glioma; Glioma - classification; Glioma - genetics; Glioma - pathology; Glioma - surgery; Histopathology; Humans; Isocitrate dehydrogenase; Isocitrate Dehydrogenase - genetics; Kaplan-Meier Estimate; Magnetic Resonance Imaging; Male; Margins of Excision; Medical prognosis; Middle Aged; Molecular pathology; Mutation; Mutation - genetics; Neoplasm Grading; Neurosurgical Procedures; Pathology; Pathology, Molecular; Patients; Surgery; Survival; Survival analysis; Tumors; Young Adult
• ISSN: 0304-3835; 1872-7980
• DOI: 10.1016/j.canlet.2021.09.008

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. •Extensive resection does not always prolong survival in specific subtypes of glioma.•Molecular pathology and clinical characteristics impact on survival in patients with glioma.•Extensive resection increased survival in specific patients with IDH-mutated astrocytoma.