Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification
Purpose To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification. Methods A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor...
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| Veröffentlicht in: | Journal of neuro-oncology 2019-12, Vol.145 (3), p.501-507 |
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| creator | Jansen, Elena Hamisch, Christina Ruess, Daniel Heiland, Dieter Henrik Goldbrunner, Roland Ruge, Maximilian I. Schnell, Oliver Grau, Stefan J. |
| description | Purpose
To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification.
Methods
A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor progression were analyzed. Progression-free survival, time to malignant transformation, post-recurrence survival, and overall survival were estimated with the Kaplan–Meier method. Prognostic factors were identified by the Log Rank test and Cox multivariate proportional hazards model.
Results
The cohort comprised 18 IDH wild type (IDH
wt
) and 53 IDH mutated (IDH
mut
) astrocytomas, and 39 IDH mutated and 1p 19q co-deleted (IDH
mut/codel
) patients. The median follow-up was 126 (95% CI 109–143) months. Surgery was gross total resection in 58, subtotal resection in 28, and biopsy in 24 patients. Progression-free survival rates at 5, 10 and 15 years was 38% 18% and 1%. The corresponding malignant transformation rates were 17%, 39% and 71%.
The initial extent of resection influenced progression-free survival, time to malignant transformation and overall survival. Molecular subtype IDH
mut/codel
was the strongest prognostic factor for overall survival and for time to malignant transformation.
Conclusion
The strongest determinant of the patients’ course after initial watchful waiting was the molecular tumor status. Extensive resection may increase time to progression and malignant transformation. Observation may be justified in selected patients. |
| doi_str_mv | 10.1007/s11060-019-03316-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2306493625</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2306493625</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-28b62d9ea600e0f716f3a29f001e2509259d188efdbacec09577d0cc1f25eaa53</originalsourceid><addsrcrecordid>eNp9kUFv1DAQhS0EotvCH-gBWeLCxWXGTuI1N1RBW6nSXkDtzfI64zRVEhc7oeq_x91tQeqBk2X7m_dG7zF2jHCCAPpzRoQGBKARoBQ2Qr9iK6y1Elpp9ZqtABstalNdH7DDnG8BoNIK37KDAkuESq3YuNlmSr_d3MeJuzBT4nlJHaUHHmLiQ7znXXIt8W7o4-i-lJepEwUbeVxmH0fi_cTnG-JD393MPIbdRRZrfnW-4X5wOfeh9zuHd-xNcEOm90_nEfv5_duP03NxuTm7OP16KXxV4SzketvI1pBrAAiCxiYoJ00AQJI1GFmbFtdrCu3WefJgaq1b8B6DrMm5Wh2xT3vduxR_LZRnO_bZ0zC4ieKSrVTQVEY18hH9-AK9jUuaynaFQlMirqUslNxTPsWcEwV7l_rRpQeLYB_LsPsybCnD7sqwugx9eJJetiO1f0ee0y-A2gO5fE0l9H_e_5H9A-ZJk9s</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2319110522</pqid></control><display><type>article</type><title>Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification</title><source>MEDLINE</source><source>SpringerLink Journals</source><creator>Jansen, Elena ; Hamisch, Christina ; Ruess, Daniel ; Heiland, Dieter Henrik ; Goldbrunner, Roland ; Ruge, Maximilian I. ; Schnell, Oliver ; Grau, Stefan J.</creator><creatorcontrib>Jansen, Elena ; Hamisch, Christina ; Ruess, Daniel ; Heiland, Dieter Henrik ; Goldbrunner, Roland ; Ruge, Maximilian I. ; Schnell, Oliver ; Grau, Stefan J.</creatorcontrib><description>Purpose
To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification.
Methods
A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor progression were analyzed. Progression-free survival, time to malignant transformation, post-recurrence survival, and overall survival were estimated with the Kaplan–Meier method. Prognostic factors were identified by the Log Rank test and Cox multivariate proportional hazards model.
Results
The cohort comprised 18 IDH wild type (IDH
wt
) and 53 IDH mutated (IDH
mut
) astrocytomas, and 39 IDH mutated and 1p 19q co-deleted (IDH
mut/codel
) patients. The median follow-up was 126 (95% CI 109–143) months. Surgery was gross total resection in 58, subtotal resection in 28, and biopsy in 24 patients. Progression-free survival rates at 5, 10 and 15 years was 38% 18% and 1%. The corresponding malignant transformation rates were 17%, 39% and 71%.
The initial extent of resection influenced progression-free survival, time to malignant transformation and overall survival. Molecular subtype IDH
mut/codel
was the strongest prognostic factor for overall survival and for time to malignant transformation.
Conclusion
The strongest determinant of the patients’ course after initial watchful waiting was the molecular tumor status. Extensive resection may increase time to progression and malignant transformation. Observation may be justified in selected patients.</description><identifier>ISSN: 0167-594X</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-019-03316-7</identifier><identifier>PMID: 31621043</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adolescent ; Adult ; Aged ; Astrocytoma ; Biopsy ; Brain Neoplasms - genetics ; Brain Neoplasms - pathology ; Brain Neoplasms - surgery ; Cell Transformation, Neoplastic - genetics ; Clinical Study ; Female ; Genetic transformation ; Glioma ; Glioma - genetics ; Glioma - pathology ; Glioma - surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Medical prognosis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Recurrence, Local - epidemiology ; Neoplasm Recurrence, Local - genetics ; Neoplasm Recurrence, Local - pathology ; Neurology ; Oncology ; Prognosis ; Progression-Free Survival ; Retrospective Studies ; Surgery ; Survival ; Watchful Waiting ; Young Adult</subject><ispartof>Journal of neuro-oncology, 2019-12, Vol.145 (3), p.501-507</ispartof><rights>Springer Science+Business Media, LLC, part of Springer Nature 2019</rights><rights>Journal of Neuro-Oncology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-28b62d9ea600e0f716f3a29f001e2509259d188efdbacec09577d0cc1f25eaa53</citedby><cites>FETCH-LOGICAL-c441t-28b62d9ea600e0f716f3a29f001e2509259d188efdbacec09577d0cc1f25eaa53</cites><orcidid>0000-0002-9742-527X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11060-019-03316-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11060-019-03316-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31621043$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Jansen, Elena</creatorcontrib><creatorcontrib>Hamisch, Christina</creatorcontrib><creatorcontrib>Ruess, Daniel</creatorcontrib><creatorcontrib>Heiland, Dieter Henrik</creatorcontrib><creatorcontrib>Goldbrunner, Roland</creatorcontrib><creatorcontrib>Ruge, Maximilian I.</creatorcontrib><creatorcontrib>Schnell, Oliver</creatorcontrib><creatorcontrib>Grau, Stefan J.</creatorcontrib><title>Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification</title><title>Journal of neuro-oncology</title><addtitle>J Neurooncol</addtitle><addtitle>J Neurooncol</addtitle><description>Purpose
To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification.
Methods
A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor progression were analyzed. Progression-free survival, time to malignant transformation, post-recurrence survival, and overall survival were estimated with the Kaplan–Meier method. Prognostic factors were identified by the Log Rank test and Cox multivariate proportional hazards model.
Results
The cohort comprised 18 IDH wild type (IDH
wt
) and 53 IDH mutated (IDH
mut
) astrocytomas, and 39 IDH mutated and 1p 19q co-deleted (IDH
mut/codel
) patients. The median follow-up was 126 (95% CI 109–143) months. Surgery was gross total resection in 58, subtotal resection in 28, and biopsy in 24 patients. Progression-free survival rates at 5, 10 and 15 years was 38% 18% and 1%. The corresponding malignant transformation rates were 17%, 39% and 71%.
The initial extent of resection influenced progression-free survival, time to malignant transformation and overall survival. Molecular subtype IDH
mut/codel
was the strongest prognostic factor for overall survival and for time to malignant transformation.
Conclusion
The strongest determinant of the patients’ course after initial watchful waiting was the molecular tumor status. Extensive resection may increase time to progression and malignant transformation. Observation may be justified in selected patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Astrocytoma</subject><subject>Biopsy</subject><subject>Brain Neoplasms - genetics</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - surgery</subject><subject>Cell Transformation, Neoplastic - genetics</subject><subject>Clinical Study</subject><subject>Female</subject><subject>Genetic transformation</subject><subject>Glioma</subject><subject>Glioma - genetics</subject><subject>Glioma - pathology</subject><subject>Glioma - surgery</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Recurrence, Local - epidemiology</subject><subject>Neoplasm Recurrence, Local - genetics</subject><subject>Neoplasm Recurrence, Local - pathology</subject><subject>Neurology</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Progression-Free Survival</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Survival</subject><subject>Watchful Waiting</subject><subject>Young Adult</subject><issn>0167-594X</issn><issn>1573-7373</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kUFv1DAQhS0EotvCH-gBWeLCxWXGTuI1N1RBW6nSXkDtzfI64zRVEhc7oeq_x91tQeqBk2X7m_dG7zF2jHCCAPpzRoQGBKARoBQ2Qr9iK6y1Elpp9ZqtABstalNdH7DDnG8BoNIK37KDAkuESq3YuNlmSr_d3MeJuzBT4nlJHaUHHmLiQ7znXXIt8W7o4-i-lJepEwUbeVxmH0fi_cTnG-JD393MPIbdRRZrfnW-4X5wOfeh9zuHd-xNcEOm90_nEfv5_duP03NxuTm7OP16KXxV4SzketvI1pBrAAiCxiYoJ00AQJI1GFmbFtdrCu3WefJgaq1b8B6DrMm5Wh2xT3vduxR_LZRnO_bZ0zC4ieKSrVTQVEY18hH9-AK9jUuaynaFQlMirqUslNxTPsWcEwV7l_rRpQeLYB_LsPsybCnD7sqwugx9eJJetiO1f0ee0y-A2gO5fE0l9H_e_5H9A-ZJk9s</recordid><startdate>20191201</startdate><enddate>20191201</enddate><creator>Jansen, Elena</creator><creator>Hamisch, Christina</creator><creator>Ruess, Daniel</creator><creator>Heiland, Dieter Henrik</creator><creator>Goldbrunner, Roland</creator><creator>Ruge, Maximilian I.</creator><creator>Schnell, Oliver</creator><creator>Grau, Stefan J.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-9742-527X</orcidid></search><sort><creationdate>20191201</creationdate><title>Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification</title><author>Jansen, Elena ; Hamisch, Christina ; Ruess, Daniel ; Heiland, Dieter Henrik ; Goldbrunner, Roland ; Ruge, Maximilian I. ; Schnell, Oliver ; Grau, Stefan J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-28b62d9ea600e0f716f3a29f001e2509259d188efdbacec09577d0cc1f25eaa53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Astrocytoma</topic><topic>Biopsy</topic><topic>Brain Neoplasms - genetics</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - surgery</topic><topic>Cell Transformation, Neoplastic - genetics</topic><topic>Clinical Study</topic><topic>Female</topic><topic>Genetic transformation</topic><topic>Glioma</topic><topic>Glioma - genetics</topic><topic>Glioma - pathology</topic><topic>Glioma - surgery</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Recurrence, Local - epidemiology</topic><topic>Neoplasm Recurrence, Local - genetics</topic><topic>Neoplasm Recurrence, Local - pathology</topic><topic>Neurology</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Progression-Free Survival</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Survival</topic><topic>Watchful Waiting</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Jansen, Elena</creatorcontrib><creatorcontrib>Hamisch, Christina</creatorcontrib><creatorcontrib>Ruess, Daniel</creatorcontrib><creatorcontrib>Heiland, Dieter Henrik</creatorcontrib><creatorcontrib>Goldbrunner, Roland</creatorcontrib><creatorcontrib>Ruge, Maximilian I.</creatorcontrib><creatorcontrib>Schnell, Oliver</creatorcontrib><creatorcontrib>Grau, Stefan J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Jansen, Elena</au><au>Hamisch, Christina</au><au>Ruess, Daniel</au><au>Heiland, Dieter Henrik</au><au>Goldbrunner, Roland</au><au>Ruge, Maximilian I.</au><au>Schnell, Oliver</au><au>Grau, Stefan J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification</atitle><jtitle>Journal of neuro-oncology</jtitle><stitle>J Neurooncol</stitle><addtitle>J Neurooncol</addtitle><date>2019-12-01</date><risdate>2019</risdate><volume>145</volume><issue>3</issue><spage>501</spage><epage>507</epage><pages>501-507</pages><issn>0167-594X</issn><eissn>1573-7373</eissn><abstract>Purpose
To provide detailed long-term data after initial observation for patients after histological confirmation of low grade (WHO II) gliomas according to molecular stratification.
Methods
A series of 110 patients with watchful waiting strategy after initial surgery for LGG and re-surgery at tumor progression were analyzed. Progression-free survival, time to malignant transformation, post-recurrence survival, and overall survival were estimated with the Kaplan–Meier method. Prognostic factors were identified by the Log Rank test and Cox multivariate proportional hazards model.
Results
The cohort comprised 18 IDH wild type (IDH
wt
) and 53 IDH mutated (IDH
mut
) astrocytomas, and 39 IDH mutated and 1p 19q co-deleted (IDH
mut/codel
) patients. The median follow-up was 126 (95% CI 109–143) months. Surgery was gross total resection in 58, subtotal resection in 28, and biopsy in 24 patients. Progression-free survival rates at 5, 10 and 15 years was 38% 18% and 1%. The corresponding malignant transformation rates were 17%, 39% and 71%.
The initial extent of resection influenced progression-free survival, time to malignant transformation and overall survival. Molecular subtype IDH
mut/codel
was the strongest prognostic factor for overall survival and for time to malignant transformation.
Conclusion
The strongest determinant of the patients’ course after initial watchful waiting was the molecular tumor status. Extensive resection may increase time to progression and malignant transformation. Observation may be justified in selected patients.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>31621043</pmid><doi>10.1007/s11060-019-03316-7</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-9742-527X</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0167-594X |
| ispartof | Journal of neuro-oncology, 2019-12, Vol.145 (3), p.501-507 |
| issn | 0167-594X 1573-7373 |
| language | eng |
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| source | MEDLINE; SpringerLink Journals |
| subjects | Adolescent Adult Aged Astrocytoma Biopsy Brain Neoplasms - genetics Brain Neoplasms - pathology Brain Neoplasms - surgery Cell Transformation, Neoplastic - genetics Clinical Study Female Genetic transformation Glioma Glioma - genetics Glioma - pathology Glioma - surgery Humans Kaplan-Meier Estimate Male Medical prognosis Medicine Medicine & Public Health Middle Aged Neoplasm Recurrence, Local - epidemiology Neoplasm Recurrence, Local - genetics Neoplasm Recurrence, Local - pathology Neurology Oncology Prognosis Progression-Free Survival Retrospective Studies Surgery Survival Watchful Waiting Young Adult |
| title | Observation after surgery for low grade glioma: long-term outcome in the light of the 2016 WHO classification |
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