Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas.
OBJECTIVE
Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The authors set out to determine factors that were independently associated with recurrence and malignant degeneration in patients who underwent resection of a hemispheric low-grade glioma.


METHODS
Adult patients who underwent craniotomy and resection of a hemispheric low-grade glioma (WHO Grade II) at the Johns Hopkins Medical Institution's academic tertiary-care institution between 1996 and 2006 were retrospectively reviewed. Multivariate proportional hazards regression analyses were used to identify associations with tumor recurrence and malignant degeneration.


RESULTS
Of the 191 consecutive patients with low-grade gliomas in this series (89 fibrillary astrocytomas, 89 oligodendrogliomas, and 13 mixed gliomas), 83 (43%) and 44 (23%) experienced tumor recurrence and malignant degeneration at last follow-up, respectively. The 5-year progression-free and malignancy-free survival rates were 44 and 74%, respectively. Independent predictors of recurrence were duration of longest lasting symptom (relative risk [RR] 0.978, 95% CI 0.954-0.996, p = 0.01), tumor size (RR 1.328, 95% CI 1.109-1.602, p = 0.002), and preoperative contrast enhancement (RR 2.558, 95% CI 1.241-5.021, p = 0.01). Independent factors associated with malignant degeneration were fibrillary astrocytoma pathology (RR 1.800, 95% CI 1.008-4.928, p = 0.04), tumor size (RR 1.086, 95% CI 1.044-1.358, p = 0.04), and gross-total resection (RR 0.526, 95% CI 0.221-1.007, p = 0.05).


CONCLUSIONS
The identification and consideration of factors associated with recurrence and malignant progression may help guide treatment strategies aimed at delaying recurrence and preventing malignant degeneration for patients with hemispheric low-grade gliomas.
Chaichana
Kaisorn L
KL
Department of Neurosurgery, Johns Hopkins Neuro-Oncology Surgical Outcomes Research Laboratory, Johns Hopkins School of Medicine, Kennedy-Krieger Institute, Baltimore, Maryland, USA.
McGirt
Matthew J
MJ
Laterra
John
J
Olivi
Alessandro
A
Quiñones-Hinojosa
Alfredo
A
D000328:Adult; D001254:Astrocytoma / Q000473:pathology / Q000601:surgery; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009837:Oligodendroglioma / Q000473:pathology / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome