Threshold of the extent of resection for WHO Grade III gliomas

Retrospective volumetric analysis of 122 cases using intraoperative MRI

Yu Fujii, Yoshihiro Muragaki, Takashi Maruyama, Masayuki Nitta, Taiichi Saito, Soko Ikuta, Hiroshi Iseki, Kazuhiro Hongo, Takakazu Kawamata

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%- 100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalJournal of Neurosurgery
Volume129
Issue number1
DOIs
Publication statusPublished - 2018 Jul 1
Externally publishedYes

Fingerprint

Glioma
Astrocytoma
Oligodendroglioma
Survival Rate
Survival
Isocitrate Dehydrogenase
Multivariate Analysis
Karnofsky Performance Status
Mutation
Tumor Burden
Radiotherapy
Retrospective Studies

Keywords

  • Extent of resection
  • Intraoperative MRI
  • Oncology
  • Removal rate
  • Survival
  • Volumetric analysis
  • WHO Grade III glioma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Threshold of the extent of resection for WHO Grade III gliomas : Retrospective volumetric analysis of 122 cases using intraoperative MRI. / Fujii, Yu; Muragaki, Yoshihiro; Maruyama, Takashi; Nitta, Masayuki; Saito, Taiichi; Ikuta, Soko; Iseki, Hiroshi; Hongo, Kazuhiro; Kawamata, Takakazu.

In: Journal of Neurosurgery, Vol. 129, No. 1, 01.07.2018, p. 1-9.

Research output: Contribution to journalArticle

Fujii, Y, Muragaki, Y, Maruyama, T, Nitta, M, Saito, T, Ikuta, S, Iseki, H, Hongo, K & Kawamata, T 2018, 'Threshold of the extent of resection for WHO Grade III gliomas: Retrospective volumetric analysis of 122 cases using intraoperative MRI', Journal of Neurosurgery, vol. 129, no. 1, pp. 1-9. https://doi.org/10.3171/2017.3.JNS162383
Fujii, Yu ; Muragaki, Yoshihiro ; Maruyama, Takashi ; Nitta, Masayuki ; Saito, Taiichi ; Ikuta, Soko ; Iseki, Hiroshi ; Hongo, Kazuhiro ; Kawamata, Takakazu. / Threshold of the extent of resection for WHO Grade III gliomas : Retrospective volumetric analysis of 122 cases using intraoperative MRI. In: Journal of Neurosurgery. 2018 ; Vol. 129, No. 1. pp. 1-9.
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title = "Threshold of the extent of resection for WHO Grade III gliomas: Retrospective volumetric analysis of 122 cases using intraoperative MRI",
abstract = "OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28{\%}, 70.59{\%}, and 65.88{\%}, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2{\%} and 67.2{\%}, respectively, and the 10-year OS rate was 62.0{\%}. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0{\%} and 79.0{\%}; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8{\%} (range 0.3{\%}-100{\%}) and 100{\%} (range 34.0{\%}- 100{\%}), respectively. A significant survival advantage was associated with resection of 53{\%} or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95{\%} CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95{\%} CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53{\%} or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.",
keywords = "Extent of resection, Intraoperative MRI, Oncology, Removal rate, Survival, Volumetric analysis, WHO Grade III glioma",
author = "Yu Fujii and Yoshihiro Muragaki and Takashi Maruyama and Masayuki Nitta and Taiichi Saito and Soko Ikuta and Hiroshi Iseki and Kazuhiro Hongo and Takakazu Kawamata",
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TY - JOUR

T1 - Threshold of the extent of resection for WHO Grade III gliomas

T2 - Retrospective volumetric analysis of 122 cases using intraoperative MRI

AU - Fujii, Yu

AU - Muragaki, Yoshihiro

AU - Maruyama, Takashi

AU - Nitta, Masayuki

AU - Saito, Taiichi

AU - Ikuta, Soko

AU - Iseki, Hiroshi

AU - Hongo, Kazuhiro

AU - Kawamata, Takakazu

PY - 2018/7/1

Y1 - 2018/7/1

N2 - OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%- 100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.

AB - OBJECTIVE WHO Grade III gliomas are relatively rare and treated with multiple modalities such as surgery, chemotherapy, and radiotherapy. The impact of the extent of resection (EOR) on improving survival in patients with this tumor type is unclear. Moreover, because of the heterogeneous radiological appearance of Grade III gliomas, the MRI sequence that best correlates with tumor volume is unknown. In the present retrospective study, the authors evaluated the prognostic significance of EOR. METHODS Clinical and radiological data from 122 patients with newly diagnosed WHO Grade III gliomas who had undergone intraoperative MRI-guided resection at a single institution between March 2000 and December 2011 were analyzed retrospectively. Patients were divided into 2 groups by histological subtype: 81 patients had anaplastic astrocytoma (AA) or anaplastic oligoastrocytoma (AOA), and 41 patients had anaplastic oligodendroglioma (AO). EOR was calculated using pre- and postoperative T2-weighted and contrast-enhanced T1-weighted MR images. Univariate and multivariate analyses were performed to evaluate the prognostic significance of EOR on overall survival (OS). RESULTS The 5-, 8-, and 10-year OS rates for all patients were 74.28%, 70.59%, and 65.88%, respectively. The 5- and 8-year OS rates for patients with AA and AOA were 72.2% and 67.2%, respectively, and the 10-year OS rate was 62.0%. On the other hand, the 5- and 8-year OS rates for patients with AO were 79.0% and 79.0%; the 10-year OS rate is not yet available. The median pre- and postoperative T2-weighted high-signal intensity volumes were 56.1 cm3 (range 1.3-268 cm3) and 5.9 cm3 (range 0-180 cm3), respectively. The median EOR of T2-weighted high-signal intensity lesions (T2-EOR) and contrast-enhanced T1-weighted lesions were 88.8% (range 0.3%-100%) and 100% (range 34.0%- 100%), respectively. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA, but not in patients with AO. Univariate analysis showed that preoperative Karnofsky Performance Scale score (p = 0.0019), isocitrate dehydrogenase 1 (IDH1) mutation (p = 0.0008), and T2-EOR (p = 0.0208) were significant prognostic factors for survival in patients with AA and AOA. Multivariate analysis demonstrated that T2-EOR (HR 3.28; 95% CI 1.22-8.81; p = 0.0192) and IDH1 mutation (HR 3.90; 95% CI 1.53-10.75; p = 0.0044) were predictive of survival in patients with AA and AOA. CONCLUSIONS T2-EOR was one of the most important prognostic factors for patients with AA and AOA. A significant survival advantage was associated with resection of 53% or more of the preoperative T2-weighted high-signal intensity volume in patients with AA and AOA.

KW - Extent of resection

KW - Intraoperative MRI

KW - Oncology

KW - Removal rate

KW - Survival

KW - Volumetric analysis

KW - WHO Grade III glioma

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