title: Velocity of tumor spontaneous expansion predicts long-term outcomes for diffuse low-grade gliomas.
abstract: BACKGROUND
  Supratentorial diffuse low-grade gliomas present a slow macroscopic tumor growth that can be quantified through the measurement of their velocity of diametric expansion. We assessed whether spontaneous velocity of diametric expansion can predict long-term outcomes as a categorical variable and as a continuous predictor.
  
  
  METHODS
  A total of 407 adult patients with newly diagnosed supratentorial diffuse low-grade gliomas in adults were studied.
  
  
  RESULTS
  The mean spontaneous velocity of diametric expansion before first-line treatment was 5.8 ± 6.3 mm/year. During the follow-up (mean, 86.5 ± 59.4 months), 209 patients presented a malignant transformation, and 87 died. The malignant progression-free survival and the overall survival were significantly longer in cases of slow velocity of diametric expansion (median, 103 and 249 months, respectively) than in cases of fast velocity of diametric expansion (median, 35 and 91 months, respectively; P < .001). In multivariate analyses, spontaneous velocity of diametric expansion as a categorical variable (<4, ≥4 and <8, ≥8 and <12, ≥12 mm/year) was an independent prognostic factor for malignant progression-free survival (P < .001; hazard ratio, 3.87; 95% confidence interval [CI], 2.67-5.52) and for overall survival (P < .001; hazard ratio, 4.62; 95% CI, 2.58-7.97). Velocity of diametric expansion was also an independent prognostic factor for overall survival as a continuous predictor, showing a linear relationship between overall survival and spontaneous velocity of diametric expansion (hazard ratio, 1.09 per one unit increase; 95% CI, 1.06-1.12; P < .001).
  
  
  CONCLUSIONS
  Independent of the molecular status, the spontaneous velocity of diametric expansion allows the identification of rapidly growing diffuse low-grade gliomas (at higher risk of worsened evolution) during the pretherapeutic period and without delaying treatment.
authors: Corresponding author: Johan Pallud, MD, Service de Neurochirurgie, Hôpital Sainte-Anne, 1 rue Cabanis, 75674 Paris Cedex 14, France. johanpallud@hotmail.com
authors: Johan
authors: J
authors: Pallud
authors: Marie
authors: M
authors: Blonski
authors: Emmanuel
authors: E
authors: Mandonnet
authors: Etienne
authors: E
authors: Audureau
authors: Denys
authors: D
authors: Fontaine
authors: Nader
authors: N
authors: Sanai
authors: Luc
authors: L
authors: Bauchet
authors: Philippe
authors: P
authors: Peruzzi
authors: Marc
authors: M
authors: Frénay
authors: Philippe
authors: P
authors: Colin
authors: Rémy
authors: R
authors: Guillevin
authors: Valérie
authors: V
authors: Bernier
authors: Marie-Hélène
authors: MH
authors: Baron
authors: Jacques
authors: J
authors: Guyotat
authors: Hugues
authors: H
authors: Duffau
authors: Luc
authors: L
authors: Taillandier
authors: Laurent
authors: L
authors: Capelle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D011379:Prognosis; D015996:Survival Rate; D047368:Tumor Burden; D055815:Young Adult
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