Surgical outcomes and survival analysis of patients with incidental low-grade gliomas

ZENG Ling-cheng; LI Hua; CHEN Ru-dong; YANG Hong-kuan; CHEN Jian; YU Jia-sheng

doi:10.13798/j.issn.1009-153X.2023.09.003

Abstract：Objective To investigate the surgical outcomes and prognostic factors of patients with incidental low-grade gliomas.Methods The clinical data of 75 patients with incidental low-grade gliomas treated surgically from January 1,2010 to December 31,2017 were retrospectively analyzed.Results Of these 75 patients,49 patients received surgery before the onset of clinical symptoms(asymptomatic group),and 26 received surgery after the onset of clinical symptoms(symptomatic group).Total resection was achieved in 59 patients(78.7%),subtotal in 13(17.3%),and partial in 3(4%).Postoperative pathological examination showed diffuse astrocytoma in 44 patients(58.7%)and oligodendroglioma in 31(41.3%).The incidence of postoperative dysfunction in the symptomatic group(11.5%,2/26)was significantly higher than that(0%)in the asymptomatic group(P<0.05).Fifty-nine patients(33 patients in the asymptomatic group and 26 patients in the symptomatic group)were followed up by MRI for 12～60 months before surgery,with an average of(30±10)months.The preoperative follow-up period of the symptomatic group was 18～60 months,with an average of(35±10)months.The preoperative follow-up period of the asymptomatic group was 12～38 months,with an average of(25±7)months.The growth rate of the 59 patients was 1～5 mm/year,with an average of(2.7±0.9)mm/year.The growth rate of the asymptomatic group was 1～5 mm/year,with an average of(2.9±0.9)mm/year.The growth rate of the symptomatic group was 1～4 mm/year,with an average of(2.5±0.7)mm/year.There was no significant difference in the growth rate of the two groups(P>0.05).Multivariate Cox regression analysis showed that the extent of tumor resection and pathological nature were independent factors affecting overall survival(OS),progression-free survival(PFS)and malignant progression free survival(MPFS).Survival curve analysis showed that the median OS,PFS and MPFS of patients with total tumor resection were significantly better than those of patients with subtotal tumor resection(P<0.05),and the median OS,PFS and MPFS of patients with oligodendroglioma were significantly better than those of patients with diffuse astrocytoma(P<0.05).Conclusions Incidental low-grade gliomas is a kind of disease with low malignant degree and slow progression.Total tumor resection is helpful to improve the survival prognosis of patients.Therefore,the timing of surgery should be fully considered to be beneficial to total tumor resection,so as to prolong the survival of patients and protect function.