Prognostic Factors for Survival in Adult Patients with Cerebral Low-Grade Glioma

Abstract

Background Low-grade gliomas are considered a therapeutic dilemma because of the heterogeneity of their clinical behavior. Patients affected by these tumors are often young and management decisions should put into consideration the potential indolent nature of these tumors and the potential long-term side effects of available therapies. Aim of the Work to analyze the collective data from studies to define prognostic factors for overall survival in adult patients with cerebral low-grade gliomas. Materials and Methods We prepared this systematic review with a careful following of the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We conducted a literature search till December 2020 using PubMed, Scopus, Web of Science, and Cochrane Library. We performed a search for all published articles that evaluated the impact of several factors (patient’s age, KPS, neurological symptoms, histological subtype, pre-op tumor size, tumor crossing the midline, tumor enhancement, extent of resection, radiotherapy, and chemotherapy) on the overall survival (OS) and progression-free survival (PFS) of adult patients with cerebral low-grade glioma (LGG), Studies were independently assessed for risk of bias using (Cochrane Risk of Bias 2.0) for randomized controlled trials, and (Newcastle–Ottawa Scale) for retrospective cohort studies. Results Patient-related factors (age was found significant according to 14 of total 19 studies, KPS according to 7 of total 11 studies, and presence of seizures according to 5 of total 7 studies). Tumor-related factors (tumor subtype was significant according to 10 of total 13 studies, IDH-mutation according to 4 of total 5 studies, 1p/19q codeletion according to 5 of total 5 studies, and tumor enhancement according to 4 of total 7 studies), and treatmentrelated factors (extent of resection was significant according to 18 of total 20 studies, while timing and dose of radiation, combined chemotherapy and radiotherapy failed to show major statistical significance, with better PFS in delayed radiotherapy “till progression”, and slightly better OS in combined chemo, radiotherapy). Conclusion Highly significant factors are extent of tumor resection, patient’s age, pre-op tumor volume and molecular subtype.