The persistence of seizures after tumor resection negatively affects survival in low-grade glioma patients: a clinical retrospective study.

Abstract

Seizures are the most common clinical manifestation of low-grade glioma (LGG). Many papers hypothesized an influence of epilepsy on glioma progression. To our knowledge, no clinical study demonstrated a direct relationship between persistence of epileptic seizures after surgery and overall survival (OS) in LGG patients. The present study aims at investigating the correlation between post-operative seizure outcome and survival in tumor-related epilepsy (TRE) patients. We performed a retrospective analysis of adult patients affected by TRE who underwent surgery for resection of LGG in a single high-volume neurosurgical center. Seizure outcome was assessed 1year after surgery and categorized according to Engel classification. Clinical, molecular and radiological features were evaluated in univariate and multivariate analyses to investigate the correlation with OS. A total of 146 patients met the inclusion criteria. Histopathological diagnosis was Diffuse Astrocytoma isocitrate dehydrogenase (IDH) wild type in 16 patients (11%), Diffuse astrocytoma IDH mutated in 89 patients (61%) and oligodendroglioma IDH mutated, 1p 19q codeleted in 41 patients (28%). 1year after surgery, 103 (70.6%) patients were in Engel class 1. Median duration of follow-up period was 69.5months. Median OS was 79.3 (72.2-86.4) months in the whole population, while it was 86.8 (78.4-95.2), 63.9 (45.7-82), 63.7 (45.2-82.2) and 47.5 (18.3-76.6) months for patients in Engel class 1, 2, 3 and 4, respectively. In a univariate analysis, Engel class evaluated 1year after surgery significantly influenced OS (p < 0.01). Multivariate analysis showed that OS was independently associated with extent of resection (p = 0.02), molecular class (p < 0.01) and Engel class (p = 0.04). Seizure control 1year after surgery significantly predicted survival of patients affected by LGG-related epilepsy in a large monocentric retrospective series. Future studies are needed to confirm these results and to assess if an epilepsy-surgical therapeutic approach may improve OS.