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Neuro Oncol. 2019 Sep 20. pii: noz168. doi: 10.1093/neuonc/noz168. [Epub ahead of print]

Predictors and early survival outcomes of maximal resection in WHO grade II 1p/19q-codeleted oligodendrogliomas.

Author information

1
Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA.
2
Department of Neurosurgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA.
3
Harvard Medical School, Boston, MA.
4
Department of Pathology, Brigham and Women's Hospital, Boston, MA.
5
Center for Neuro-Oncology, Department of Medical Oncology, Dana-Farber Cancer Center, Boston, MA.
6
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA.

Abstract

BACKGROUND:

Although surgery plays a crucial diagnostic role in WHO grade II 1p/19q-codeleted oligodendrogliomas, the role of maximal tumor surgical resection remains unclear, with early retrospective series limited by lack of molecular classification or appropriate control groups.

METHODS:

The characteristics, management, and overall survival (OS) of patients ≥20y.o. presenting with histology-proven WHO grade II 1p/19q-codeleted oligodendrogliomas during 2010-2016 were evaluated using the National Cancer Database and validated using multi-institutional data. Patients were stratified by watchful-waiting (biopsy-only) vs. surgical resection. OS was analyzed using Kaplan-Meier methods and risk-adjusted proportional hazards.

RESULTS:

590 adults met inclusion criteria, of which 79.0% (n=466) underwent surgical resection. Of patient and tumor characteristics, younger patients were more likely to be resected. Achieving gross total resection (GTR; n=320) was significantly associated with smaller tumors, management at integrated network cancer programs (vs. community cancer programs), and Medicare insurance (as compared to no, private, or Medicaid/other government insurance) and independent of other patient or tumor characteristics. In risk-adjusted analyses, GTR, but not subtotal resection (STR), demonstrated improved OS (vs. biopsy-only: HR 0.28, 95CI: 0.09-0.85, p=0.02).

CONCLUSIONS:

WHO grade II 1p/19q-codeleted oligodendrogliomas amenable to resection demonstrated improved OS with GTR, but not STR, compared to biopsy-only watchful-waiting. The OS benefits of GTR were independent of age, tumor size, or tumor location. Medicare-insured and integrated network cancer program patients were significantly more likely to have GTR than other patients, suggesting that insurance status and care setting may play important roles in access to timely diagnosis or innovations that improve maximal resection.

KEYWORDS:

Extent of resection; Low-grade; Oligodendroglioma; Watchful waiting

PMID:
31538193
DOI:
10.1093/neuonc/noz168

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