Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas
Open accessAbstract
Purpose: The prognostic role of extent of resection (EOR) of low-grade gliomas (LGGs) is a major controversy. We designed a retrospective study to assess the influence of EOR on long-term outcomes of LGGs. Patients and Methods: The study population (N = 216) included adults undergoing initial resection of hemispheric LGG. Region-of-interest analysis was performed to measure tumor volumes based on fluid-attenuated inversion-recovery (FLAIR) imaging. Results: Median preoperative and postoperative tumor volumes and EOR were 36.6 cm 3 (range, 0.7 to 246.1 cm 3), 3.7 cm 3 (range, 0 to 197.8 cm 3) and 88.0% (range, 5% to 100%), respectively. There was no operative mortality. New postoperative deficits were noted in 36 patients (17%); however, all but four had complete recovery. There were 34 deaths (16%; median follow-up, 4.4 years). Progression and malignant progression were identified in 95 (44%) and 44 (20%) cases, respectively. Patients with at least 90% EOR had 5- and 8-year overall survival (OS) rates of 97% and 91%, respectively, whereas patients with less than 90% EOR had 5- and 8-year OS rates of 76% and 60%, respectively. After adjusting each measure of tumor burden for age, Karnofsky performance score (KPS), tumor location, and tumor subtype, OS was predicted by EOR (hazard ratio [HR] = 0.972; 95% CI, 0.960 to 0.983; P < .001), log preoperative tumor volume (HR = 4.442; 95% CI, 1.601 to 12.320; P = .004), and postoperative tumor volume (HR = 1.010; 95% CI, 1.001 to 1.019; P = .03), progression-free survival was predicted by log preoperative tumor volume (HR = 2.711; 95% CI, 1.590 to 4.623; P ≤ .001) and postoperative tumor volume (HR = 1.007; 95% CI, 1.001 to 1.014; P = .035), and malignant progression-free survival was predicted by EOR (HR = 0.983; 95% CI, 0.972 to 0.995; P = .005) and log preoperative tumor volume (HR = 3.826; 95% CI, 1.632 to 8.969; P = .002). Conclusion: Improved outcome among adult patients with hemispheric LGG is predicted by greater EOR.
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Early maximal safe resection is now favored over watchful waiting for LGGs.
“Despite historical controversy regarding surgical management of LGGs, early maximal safe resection is now favored over the watchful waiting approach [27,37,38,39,40].”
From BPC 157 Therapy of Myotendinous Junction Injury in Rats (2025) · cites this paper as [27]
The Discussion argues strongly for maximal resection, and the conclusion recommends it when feasible for adults with hemispheric LGG. But the Introduction says surgical management remains controversial and that alternatives remain acceptable; the study does not directly compare early resection with watchful waiting or establish that resection is now generally favored. Page numbers are not provided in our copy. (LLM, conf=0.86)
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“His enhancement of his tumor at compared to an enhancing glioma management of LGGs, early approach [27,37–40].”
- Authors
- Smith, J. S., Chang, E. F., Lamborn, K. R., Chang, S. M., Prados, M. D., Cha, S., Tihan, T., VandenBerg, S., McDermott, M. W., & Berger, M. S.
- Affiliations
- University of California, San Francisco (US)
- From the Department of Neurological Surgery, Brain Tumor Research Center, University of California, San Francisco, CA
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2008-03-10
- Volume
- 26
- Issue
- 8
- Pages
- 1338-1345
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- OpenAlex
- W2134942438
- Cited by
- 1,283
- References
- 34
- Citations by year
- 2026: 27 · 2025: 42 · 2024: 49 · 2023: 61 · 2022: 81 · 2021: 77 · 2020: 87 · 2019: 109 · 2018: 92 · 2017: 105 · 2016: 70 · 2015: 86 · 2014: 74 · 2013: 86 · 2012: 78
- FWCI
- 24.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Genetics › Glioma Diagnosis and Treatment
- Health Sciences › Medicine › Reproductive Medicine › Ovarian cancer diagnosis and treatment
- Health Sciences › Medicine › Epidemiology › Meningioma and schwannoma management
- Keywords
- extent of resection, low-grade glioma, overall survival, progression-free survival, tumor volume, prognostic factors, malignant transformation, postoperative deficits, Karnofsky performance status, FLAIR MRI, surgical resection margin, prognostic nomogram, risk stratification, postoperative radiotherapy, adjuvant chemotherapy
- MeSH terms
- Adult, Astrocytoma, Brain Neoplasms, Female, Humans, Male, Middle Aged, Oligodendroglioma, Prognosis, Retrospective Studies, Survival Rate, Treatment Outcome
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