The role of extent of resection on the prognosis of low-grade astrocytoma: a systematic review and meta-analysis

Abstract

Purpose To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of low-grade astrocytoma. Materials and methods A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to November 14, 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the hazards ratio (HR) and corresponding 95% confidence interval. Result Five cohort studies were selected for meta-analysis. There was statistically significant effect of total resection on increase mortality after surgery in low-grade astrocytoma patients (HR = 0.70 [0.52, 0.94]; p = 0.02; I2 = Not applicable). On the other hand, there was statistically nonsignificant effect of patient’s age (HR = 1.27 [0.95, 1.68]; p = 0.11; I2 = 83%), tumor size (HR = 1.13 [0.94, 1.35]; p = 0.19; I2 = 73%), and increasing KPS (HR = 0.59 [0.20, 1.77]; p = 0.35; I2 = 86%) on prognosis of low-grade astrocytoma after surgery. Conclusion The results of meta-analysis showed significant relationship of extent of resection and mortality, while factors such age, KPS score, and tumor size were nonsignificant to determine mortality in patient diagnosed with low-grade astrocytoma. The gross total resection surgery should be preferred over subtotal resection since the incidence of malignant formation is low in gross total resection.

Update for astrocytomas: medical and surgical management considerations

“…Radiation, chemotherapy, and surgical resection play a role in the medical management of both low-and high-grade astrocytomas to alleviate symptoms, improve prognosis, and prevent malignant transformation [11,12]. By summarizing the current understanding of astrocytomas, this paper strives to consolidate and clearly explain the accepted medical and surgical management of this condition to better educate the reader.…”