Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic

Schomas, David A.; Laack, Nadia N.; Rao, Ravi A.; Meyer, Fredric B.; Shaw, Edward G.; O’Neill, Brian Patrick; Giannini, Caterina; Brown, Paul D.

doi:10.1215/15228517-2008-102

Cited by 163 publications

(111 citation statements)

References 41 publications

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“…Median PFS was approximately 17 months, which was shorter in other studies of LGG that include all ages of adults [9,17]. Our retrospective analysis confirms findings in prior studies [1,9,18,19], showing a decrease in overall survival and progression-free survival in older LGG patients over the age of 50 compared to patients < 50. One prior long-term analysis from the Mayo Clinic showed an overall survival of older LGG patients (> 55 years) to be 32.4 months; however their cohort had only one patient who underwent a GTR.…”

Section: Discussionsupporting

confidence: 87%

“…[1,9,[14][15][16] This suggests that LGG in patients > 50 are likely to behave more aggressively and might benefit from upfront treatment. This age-related discrepancy in grade 2 LGG is seen when comparing adult LGG to childhood LGG.…”

Section: Discussionmentioning

confidence: 99%

“…LGGs are more common in younger adults with a peak age of 34 years and clinically behave more aggressively than LGG diagnosed in the pediatric population [1]. In children, grade 2 LGG may be curable with gross total resection alone [2].…”

Section: Introductionmentioning

confidence: 99%

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Prognosis of older patients with low-grade glioma: A retrospective study

Kumthekar¹,

Patel²,

Bridge³

et al. 2017

Integr Cancer Sci Therap

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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Prognosis of older patients with low-grade glioma: A retrospective study

Kumthekar¹,

Patel²,

Bridge³

et al. 2017

Integr Cancer Sci Therap

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“…While these tumors have been demonstrated to have varying prognoses, LGAs are often considered to be a homogeneous group with a similar prog- nosis. 28,29 However, there is increasing suggestion that LGAs may have unique histological subtypes that may affect the risk of malignant transformation and overall survival. In this study, we have analyzed the largest collection of gemistocytic and protoplasmic astrocytomas and have for the first time compared the patient characteristics and outcome between all 3 subtypes.…”

Section: Discussionmentioning

confidence: 99%

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Babu

Bagley

Park

et al. 2013

JNS

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Object Low-grade astrocytomas are slow-growing, infiltrative gliomas that over time may progress into more malignant tumors. Various factors have been shown to affect the time to progression and overall survival including age, performance status, tumor size, and the extent of resection. However, more recently it has been suggested that histological subtypes (fibrillary, protoplasmic, and gemistocytic) may impact patient outcome. In this study the authors have performed a large comparative population-based analysis to examine the characteristics and survival of patients with the various subtypes of WHO Grade II astrocytomas. Methods Patients diagnosed with fibrillary, protoplasmic, and gemistocytic astrocytomas were identified through the Surveillance, Epidemiology, and End Results (SEER) database. The chi-square test and Student t-test were used to evaluate differences in patient and treatment characteristics between astrocytoma subtypes. Kaplan-Meier analysis was used to assess overall survival, and the log-rank test was used to evaluate the differences between survival curves. Univariate and multivariate analyses were also performed to determine the effect of various patient, tumor, and treatment variables on overall survival. Results A total of 500 cases were included in the analysis, consisting of 326 fibrillary (65.2%), 29 protoplasmic (5.8%), and 145 gemistocytic (29%) variants. Gemistocytic astrocytomas presented at a significantly older age than the fibrillary variant (46.8 vs 37.7 years, p < 0.0001), with protoplasmic and fibrillary subtypes having a similar age. Although protoplasmic and fibrillary variants underwent radiotherapy at similar rates, gemistocytic tumors more frequently received radiotherapy (p = 0.0001). Univariate analysis revealed older age, larger tumor size, and the use of radiotherapy to be poor prognostic factors, with resection being associated with improved survival. The gemistocytic subtype (hazard ratio [HR] 1.62 [95% CI 1.27–2.07], p = 0.0001) also resulted in significantly worse survival than fibrillary tumors. Bivariate analyses demonstrated that older age, the use of radiotherapy, and resection significantly influenced median survival. Tumor subtype also affected median survival; patients who harbored gemistocytic tumors experienced less than half the median survival of fibrillary and protoplasmic tumors (38 vs 82 months, p = 0.0003). Multivariate analysis revealed increasing age (HR 1.05 [95% CI 1.04–1.05], p < 0.0001), larger tumor size (HR 1.02 [95% CI 1.01–1.03], p = 0.0002), and the use of resection (HR 0.70 [95% CI 0.52–0.94], p = 0.018) to be independent predictors of survival. Examination of tumor subtype revealed that the gemistocytic variant (HR 1.30 [95% CI 0.98–1.74], p = 0.074) was associated with worse patient survival than fibrillary tumors, although this only approached significance. The protoplasmic subtype did not affect overall survival (p = 0.33). Conclusions Gemistocytic tumor histology was associated with worse survival than fibrillary and protoplasmic astrocytomas. As protoplasmic astrocytomas have a survival similar to fibrillary tumors, there may be limited utility to the identification of this rare variant. However, increased attention should be paid to the presence of gemistocytes in low-grade gliomas as this is associated with shorter time to progression, increased malignant transformation, and reduced overall survival.

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“…removal, as patients with more extensive tumor resection had significantly longer OS 11,[14][15][16]19,20 . Our data showed a very similar KPS at diagnosis between these two groups.…”

Section: Referencesmentioning

confidence: 99%

Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

Bianco

Miura²,

Clara

et al. 2013

Arq. Neuro-Psiquiatr.

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A retrospective study of 81 patients with low-grade astrocytoma (LGA) comparing the efficacy of aggressive versus less aggressive surgery in eloquent and non-eloquent brain areas was conducted. Extent of surgical resection was analyzed to assess overall survival (OS) and progression- free survival (PFS). Degree of tumor resection was classified as gross total resection (GTR), subtotal resection (STR) or biopsy. GTR, STR and biopsy in patients with tumors in non-eloquent areas were performed in 31, 48 and 21% subjects, whereas in patients with tumors in eloquent areas resections were 22.5, 35 and 42.5%. Overall survival was 4.7 and 1.9 years in patients with tumors in non-eloquent brain areas submitted to GTR/STR and biopsy (p=0.013), whereas overall survival among patients with tumors in eloquent area was 4.5 and 2.1 years (p=0.33). Improved outcome for adult patients with LGA is predicted by more aggressive surgery in both eloquent and non-eloquent brain areas.

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Intracranial low-grade gliomas in adults: 30-year experience with long-term follow-up at Mayo Clinic

Cited by 163 publications

References 41 publications

Prognosis of older patients with low-grade glioma: A retrospective study

Prognosis of older patients with low-grade glioma: A retrospective study

Low-grade astrocytomas: the prognostic value of fibrillary, gemistocytic, and protoplasmic tumor histology

Low-grade astrocytoma: surgical outcomes in eloquent versus non-eloquent brain areas

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