title: Preoperative prognostic classification system for hemispheric low-grade gliomas in adults.
abstract: OBJECTIVE
  Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs.
  
  
  METHODS
  The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system.
  
  
  RESULTS
  The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71-10.42), Karnofsky Performance Scale score < or = 80 (HR 3.53, 95% CI 1.56-8.00), patient age > 50 years (HR 1.96, 95% CI 1.47-3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43-8.06). A scoring system calculated from the sum of these factors (range 0-4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0-1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3-4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described.
  
  
  CONCLUSIONS
  The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.
authors.affiliation: Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California 94143, USA. ChangEd@neurosurg.ucsf.edu
authors.forename: Edward F
authors.initials: EF
authors.lastname: Chang
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Susan M
authors.initials: SM
authors.lastname: Chang
authors.forename: Kathleen R
authors.initials: KR
authors.lastname: Lamborn
authors.forename: Michael D
authors.initials: MD
authors.lastname: Prados
authors.forename: Nicholas
authors.initials: N
authors.lastname: Butowski
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Barbaro
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Parsa
authors.forename: Mitchel S
authors.initials: MS
authors.lastname: Berger
authors.forename: Michael M
authors.initials: MM
authors.lastname: McDermott
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D005910:Glioma / Q000145:classification* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult