Abstract
PurposeThe aim of this study was to investigate the epidemiological characteristics and associated risk factors of recurrent lower-grade glioma [LGG] (WHO grades II and III) according to the 2016 updated WHO classification paradigm and finally develop a model for predicting early mortality (succumb within a year after reoperation) in recurrent LGG patients.MethodsData were obtained from consecutive patients who underwent surgery for primary LGG and reoperation for tumor recurrence. The end point “early mortality” was defined as death within 1 year after the reoperation. Predictive factors, including basic clinical characteristics and laboratory data, were retrospectively collected.ResultsA final nomogram was generated for surgically treated recurrent LGG. Factors that increased the probability of early mortality included older age (P = 0.042), D-dimer> 0.187 (P = 0.007), RDW > 13.4 (P = 0.048), PLR > 100.749 (P = 0.014), NLR > 1.815 (P = 0.047), 1p19q intact (P = 0.019), IDH1-R132H Mutant (P = 0.048), Fib≤2.80 (P = 0.018), lack of Stupp concurrent chemoradiotherapy (P = 0.041), and an initial symptom of epilepsy (P = 0.047). The calibration curve between the prediction from this model and the actual observations showed good agreement.Conclusion: A nomogram that predicts individualized probabilities of early mortality for surgically treated recurrent LGG patients could be a practical clinical tool for counseling patients regarding treatment decisions and optimizing therapeutic approaches. Free online software implementing this nomogram is provided at https://warrenwrl.shinyapps.io/RecurrenceGliomaEarlyM/
Highlights
Gliomas are among the most common adult brain tumors
Isocitrate dehydrogenase 1 (IDH1) isocitrate dehydrogenase 1, Alpha thalassemia/mental retardation syndrome X-linked (ATRX) alpha thalassemia/mental retardation syndrome X-linked, Neutrophil-to-Lymphocyte Ratio (NLR) the neutrophil-to-lymphocyte ratio, Platelet-to-Lymphocyte Ratio (PLR) the platelet-tolymphocyte ratio, Lymphocyte-to-Monocyte Ratio (LMR) the lymphocyte-to-monocyte ratio, Red blood cell Distribution Width (RDW) red blood cell distribution width, Fibrinogen Level (FIB) fibrinogen, D-Dimer Level (DD) D-dimer, IQR interquartile range, TTRtime to recurrence, Overall survival (OS) overall survival (HR = 2.707, 95% CI = 1.001–7.321) and 1p19q (HR = 0.265, 95% CI 0.098–0.718; P = 0.009) remained independently associated with early mortality after reoperation
Discussion recent research indicates that lower-grade glioma (LGG) patients could gain a survival benefit from repeat surgery after tumor recurrence, surgical treatment has not been widely accepted as a standard recurrent LGG treatment protocol due to an insufficient number of studies
Summary
Gliomas are among the most common adult brain tumors. Unlike cancers originating from other organs, tumors in the central nervous system (CNS) obey a unique histological and grading system [1]. The primary role of reoperation in the management of recurrent low-grade gliomas has not been clarified [3], but studies have confirmed that reoperation provides a significant benefit for patients with recurrent LGG [4]. The rationality of reoperation could be questioned if the patient succumbs to death within one year after reoperation of recurrent LGG, especially as salvage chemotherapy may prolong patient post recurrence survival than one year. To this end, in the present study, we generated and validated a nomogram to assist clinical decision-making by distinguishing recurrent LGG patients at high risk of early mortality
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