The prognostic value of maximal surgical resection is attenuated in oligodendroglioma subgroups of adult diffuse glioma: a multicenter retrospective study
机构：[1]Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Mid Wulumuqi Road, Shanghai, China[2]Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China研究所北京市神经外科研究所首都医科大学附属天坛医院[3]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China重点科室诊疗科室神经外科神经外科首都医科大学附属天坛医院[4]Department of Neurosurgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, China[5]Neurosurgical Immunology Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China[6]Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China[7]Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China[8]Department of Pathology, Basic Medical Science, Fudan University, Shanghai, China[9]Evidence Based Medicine Center, Fudan University, Shanghai, China[10]Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA[11]Department of Neuro?Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
Purpose Maximal surgical resection is associated with survival benefit in the majority of studies in adult diffuse glioma. This study aims to characterize the prognostic value of surgical resection in molecular subgroups of diffuse glioma. Methods 1178 patients with diffuse glioma from our centers and 422 from TCGA dataset were collected. The Kaplan-Meier analysis and multivariable Cox regression models were conducted to identify the prognostic value of surgical resection through different histological and molecular stratifications. Results Firstly, we confirmed progression-free survival (PFS) benefit associated with gross total resection (GTR) over sub-total resection (STR) in lower-grade glioma (HR 1.49; 95% CI 1.17-1.90; P = 0.001). Intriguingly however, we were unable to detect a significant PFS or overall survival (OS) benefit in oligodendroglioma (N = 397; HR 1.36; 95% CI 0.86-2.14; P = 0.19 and HR 1.05; 95% CI 0.55-1.99; P = 0.89, respectively). Secondly, when analyzed in molecular subgroups, we were similarly unable to detect a significant PFS or OS benefit in IDH MT/codel subgroup (N = 269; HR 1.47; 95% CI 0.92-2.34; P = 0.11 and HR 1.54; 95% CI 0.78-3.05; P = 0.21, respectively), oligodendroglioma with IDH MT/codel subgroup (N=233; HR 1.33; 95% CI 0.79-2.21; P = 0.28 and HR 1.16; 95% CI 0.53-2.54; P = 0.70, respectively) or other relevant subgroups. TCGA validation also showed a significant survival benefit in astrocytoma rather than oligodendroglioma. Exploratory RNAseq analysis displayed that fewer cell proliferation-related gene expression features were specific to oligodendroglioma. Conclusion These results suggest that the benefit of maximal surgery may be attenuated in patients within oligodendroglioma relevant subgroups because of the chemosensitive and indolent nature. The aggressive surgery accompanying with risk of neurologic morbidity may be unnecessary for these patients given the lack of survival benefit with gross total resection.
基金：
Research Special Fund for Public Welfare Industry of Health [201402008]; National Key Research and Development Plan [2016YFC0902500]
第一作者机构：[1]Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Mid Wulumuqi Road, Shanghai, China
共同第一作者：
通讯作者：
通讯机构：[1]Department of Neurosurgery, Huashan Hospital, Fudan University, 12# Mid Wulumuqi Road, Shanghai, China[2]Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China[3]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, 6# Tiantanxili, Beijing, China[5]Neurosurgical Immunology Laboratory, Neurosurgical Institute of Fudan University, Shanghai, China[11]Department of Neuro?Oncology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
推荐引用方式(GB/T 7714)：
Ding Xiaojie,Wang Zheng,Chen Di,et al.The prognostic value of maximal surgical resection is attenuated in oligodendroglioma subgroups of adult diffuse glioma: a multicenter retrospective study[J].JOURNAL OF NEURO-ONCOLOGY.2018,140(3):591-603.doi:10.1007/s11060-018-2985-3.
APA：
Ding, Xiaojie,Wang, Zheng,Chen, Di,Wang, Yinyan,Zhao, Zheng...&Zhou, Liangfu.(2018).The prognostic value of maximal surgical resection is attenuated in oligodendroglioma subgroups of adult diffuse glioma: a multicenter retrospective study.JOURNAL OF NEURO-ONCOLOGY,140,(3)
MLA：
Ding, Xiaojie,et al."The prognostic value of maximal surgical resection is attenuated in oligodendroglioma subgroups of adult diffuse glioma: a multicenter retrospective study".JOURNAL OF NEURO-ONCOLOGY 140..3(2018):591-603
