Preoperative Patient-Reported Outcomes in Suspected Low-Grade Glioma: Markers of Disease Severity and Correlations with Molecular Subtypes.

Dongni Buvarp,Anja Smits,Thomas Olsson Bontell,Isabelle Rydén,Tomás Gómez Vecchio,Katharina S Sunnerhagen,Asgeir Store Jakola

doi:10.3390/jcm10040645

Abstract

This prospective study aims to determine the overall health-related quality of life (HRQoL), functioning, fatigue, and psychological distress preoperatively in patients with suspected diffuse low-grade glioma (dLGG). We were particularly interested if these parameters differed by molecular tumor subtypes: oligodendroglioma, IDHmut astrocytoma and IDHwt astrocytoma. Fifty-one patients answered self-assessed questionnaires prior to operation (median age 51 years; range 19–75; 19 females [37%]). Thirty-five (69%) patients had IDH-mutated tumors, of which 17 were 1p/19q codeleted (i.e., oligodendroglioma) and 18 non-1p/19q codeleted (i.e., IDHmut astrocytoma). A lower overall generic HRQoL was associated with a high level of fatigue (rs = −0.49, p < 0.001), visual disorder (rs = −0.5, p < 0.001), motor dysfunction (rs = −0.51, p < 0.001), depression (rs = −0.54, p < 0.001), and reduced functioning. Nearly half of the patients reported high fatigue (23 out of 51 patients) and anxiety (26/51 patients). Patients with IDHwt had worse generic HRQoL, worse functioning, and more severe fatigue, though differences were not statistically significant between the molecular subtypes. In conclusion, fatigue and anxiety are prominent self-assessed symptoms of patients with suspected dLGG in a preoperative setting, but do not seem to be a reliable method to make assumptions of underlying biology or guide treatment decisions.

Highlights

The latest WHO classification for diffuse low-grade glioma (dLGG) has incorporated molecular markers based on genetic classification [7], such as isocitrate dehydrogenase (IDH1 or IDH2) mutation and codeletion of chromosome arms 1p and 19q, thereby addressing the previous limitations in the histological classification with problematic inter-rater variability and imperfect prediction of outcomes [8,9]
Patients were identified through the weekly multidisciplinary tumor board (MDTB) meetings, where the possible dLGG diagnosis was noted
Patients with suspected dLGG were classified into three categories based on molecular subtypes: patients with IDH mutation and 1p/19q codeletion, patients with IDH mutation and non-1p/19q codeletion (i.e., IDHmut astrocytoma), and patients with IDH wildtype (IDHwt) (i.e., IDHwt astrocytoma)

Summary

Introduction

Diffuse low-grade gliomas (dLGG) are slow-growing, infiltrative primary brain tumors typically affecting young or middle-aged adults. Given its infiltrative and invasive nature, treatment strategies including neurosurgical resection, chemotherapy, or radiation therapy cannot fully eradicate tumor cells, imposing a major challenge to the clinical management in patients with suspected dLGG [5]. Patients with IDH wildtype (IDHwt) LGG show a clinical course similar to primary glioblastoma and significantly shorter survival time than those with IDH-mutated (IDHmut) tumors of similar malignancy grade [6]. Treatment responses differ considerably among patients with different molecular profiles [10,11,12]

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