Neurosurgery Unit, Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy.
Department of Neurosurgery, Gui de Chauliac Hospital, Montpellier University Medical Center, Montpellier, France.
Neuro Oncol. 2022 Apr 1;24(4):624-638. doi: 10.1093/neuonc/noab210.
The role of surgery for incidentally discovered diffuse incidental low-grade gliomas (iLGGs) is debatable and poorly documented in current literature.
The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population.
Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR).
The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2%, respectively. OS was significantly longer for patients with a lower preoperative tumor volume (P = .001) and higher extent of resection (EOR) (P = .037), regardless the WHO-defined molecular class (P = .2). In the final model, OS was influenced only by the preoperative tumor volume (P = .006), while TR by early surgery (P = .028). A negative association was found between preoperative tumor volumes and EOR (rs = -0.44, P < .001). The median preoperative tumor volume was 15 cm3. The median EOR was 95%. Total or supratotal resection of T2-FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high-grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases.
This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favor of early surgery for these lesions.
在当前文献中，对于偶然发现的弥漫性低级胶质瘤（iLGG）的手术作用存在争议，且记录不佳。
旨在确定在大型多中心人群中接受 iLGG 手术切除的患者生存的影响因素。
对 4 个神经外科中心的 267 例 iLGG 患者的临床、影像学和手术数据进行回顾性分析。进行单因素和多因素分析以确定总生存率（OS）和肿瘤复发（TR）的预测因素。
OS 率为 92.41%。5 年和 10 年的估计 OS 率分别为 98.09%和 93.2%。术前肿瘤体积较低（P=0.001）和 EOR 较高（P=0.037）的患者 OS 明显更长，而与 WHO 定义的分子类型无关（P=0.2）。在最终模型中，仅术前肿瘤体积（P=0.006）影响 OS，而 TR 则受早期手术（P=0.028）影响。术前肿瘤体积与 EOR 呈负相关（rs=-0.44，P<0.001）。术前肿瘤体积的中位数为 15cm3。EOR 的中位数为 95%。61.62%的病例实现了 T2-FLAIR 异常的全切除或近全切除。26.22%的病例进行了二次手术。两次手术之间的中位时间为 5.5 年。22.85%的病例（16/70）检测到组织学演变为高级别胶质瘤。3.08%的病例出现永久性轻度缺陷。
这项多中心研究证实了先前研究调查 iLGG 手术治疗的结果，从而加强了支持对这些病变进行早期手术的证据。
