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000306605 1001_ $$aKarschnia, Philipp$$b0
000306605 245__ $$aA prognostic classification system for extent of resection in IDH-mutant grade 2 glioma: an international, multicentre, retrospective cohort study with external validation by the RANO resect group.
000306605 260__ $$aLondon$$bThe Lancet Publ. Group$$c2025
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000306605 520__ $$aThe efficacy of resection in IDH-mutant grade 2 gliomas remain controversial since terminology for the extent of resection has been inconsistently applied across studies. We aimed to establish a standardised classification for the extent of resection and assess the association between supramaximal resection and survival across molecular subtypes.In this international, multicentre, retrospective study, patients aged 18 years and older with newly diagnosed grade 2 IDH-mutant glioma were identified from institutional databases across 16 centres in the USA, Europe, and Asia between between Sept 1, 1993, and May 10, 2024. We used Cox proportional hazard regressions to analyse the associations between residual tumour and progression-free survival and overall survival. Patients were stratified according to a previously postulated classification system based on residual tumour volume. A cohort of patients from UCSF diagnosed between Feb 16, 1998, and Nov 14, 2017, was used for geographically and institutionally independent external validation.We identified 1391 patients with newly diagnosed IDH-mutant grade 2 gliomas, with a median follow-up of 81 months (95% CI 78-85). 728 patients (379 with astrocytoma and 349 with oligodendroglioma) received no first-line treatment beyond surgery, allowing us to study the isolated effects of resection. Patients with maximal T2-fluid attenuated inversion recovery (T2-FLAIR) resection (class 2; 0-5 cm3 remnant) had superior progression-free and overall survival compared with submaximal T2-FLAIR resection (class 3; 5-25 cm3 remnant) or minimal T2-FLAIR resection (class 4; >25 cm3 remnant), with 10-year survival rates of 82% (95% CI 76-87) versus 75% (62-84) versus 48% (29-65; p<0·0001) and 5-year progression-free survival rates of 44% (38-50) versus 25% (16-34) versus 12% (4-24; p<0·0001), respectively. Resection beyond T2-FLAIR borders (class 1) provided survival benefits, with a 10-year survival rate of 98% (95% CI 92-99) and a 5-year progression-free survival rate of 83% (76-88) for supramaximal T2-FLAIR resection (class 1). Associations between survival and extensive resection were evident after 3 years in astrocytomas, whereas survival curves separated after 6-8 years in oligodendrogliomas. The prognostic relevance of the four-tier classification was conserved in multivariable analyses, in 625 patients receiving first-line chemotherapy or radiotherapy (with or without chemotherapy), and in the external UCSF cohort of 381 patients with IDH-mutant grade 2 gliomas.The proposed RANO classification for extent of resection could serve as a tool for prognostic stratification. Although associations between survival and extensive surgery are evident sooner in patients with astrocytoma, supramaximal resection also translates into survival benefits for patients with oligodendrogliomas.None.
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000306605 650_7 $$0EC 1.1.1.41$$2NLM Chemicals$$aIsocitrate Dehydrogenase
000306605 650_7 $$0EC 1.1.1.41$$2NLM Chemicals$$aIDH2 protein, human
000306605 650_2 $$2MeSH$$aHumans
000306605 650_2 $$2MeSH$$aMiddle Aged
000306605 650_2 $$2MeSH$$aFemale
000306605 650_2 $$2MeSH$$aIsocitrate Dehydrogenase: genetics
000306605 650_2 $$2MeSH$$aMale
000306605 650_2 $$2MeSH$$aRetrospective Studies
000306605 650_2 $$2MeSH$$aAdult
000306605 650_2 $$2MeSH$$aBrain Neoplasms: surgery
000306605 650_2 $$2MeSH$$aBrain Neoplasms: genetics
000306605 650_2 $$2MeSH$$aBrain Neoplasms: pathology
000306605 650_2 $$2MeSH$$aBrain Neoplasms: mortality
000306605 650_2 $$2MeSH$$aBrain Neoplasms: classification
000306605 650_2 $$2MeSH$$aMutation
000306605 650_2 $$2MeSH$$aGlioma: surgery
000306605 650_2 $$2MeSH$$aGlioma: genetics
000306605 650_2 $$2MeSH$$aGlioma: pathology
000306605 650_2 $$2MeSH$$aGlioma: mortality
000306605 650_2 $$2MeSH$$aPrognosis
000306605 650_2 $$2MeSH$$aNeoplasm Grading
000306605 650_2 $$2MeSH$$aAged
000306605 650_2 $$2MeSH$$aProgression-Free Survival
000306605 650_2 $$2MeSH$$aYoung Adult
000306605 650_2 $$2MeSH$$aNeurosurgical Procedures: mortality
000306605 650_2 $$2MeSH$$aNeoplasm, Residual
000306605 7001_ $$aYoung, Jacob S$$b1
000306605 7001_ $$aWijnenga, Maarten M J$$b2
000306605 7001_ $$aSciortino, Tommaso$$b3
000306605 7001_ $$aTeske, Nico$$b4
000306605 7001_ $$aCorell, Alba$$b5
000306605 7001_ $$aWagner, Arthur$$b6
000306605 7001_ $$aYoussef, Gilbert$$b7
000306605 7001_ $$aPark, Yae Won$$b8
000306605 7001_ $$aHäni, Levin$$b9
000306605 7001_ $$aJünger, Stephanie T$$b10
000306605 7001_ $$aDono, Antonio$$b11
000306605 7001_ $$0P:(DE-HGF)0$$aEhret, Felix$$b12
000306605 7001_ $$aMireles, Eduardo E Mendoza$$b13
000306605 7001_ $$aNeidert, Nicolas$$b14
000306605 7001_ $$aBruno, Francesco$$b15
000306605 7001_ $$aTuchek, Chad A$$b16
000306605 7001_ $$avan der Vaart, Thijs$$b17
000306605 7001_ $$aRossi, Marco$$b18
000306605 7001_ $$aNibali, Marco Conti$$b19
000306605 7001_ $$aGay, Lorenzo$$b20
000306605 7001_ $$aGramelt, Alfred$$b21
000306605 7001_ $$aTandon, Nitin$$b22
000306605 7001_ $$aAhn, Sung Soo$$b23
000306605 7001_ $$aChang, Jong Hee$$b24
000306605 7001_ $$aWeller, Michael$$b25
000306605 7001_ $$aVincent, Arnaud J P E$$b26
000306605 7001_ $$aGoldbrunner, Roland$$b27
000306605 7001_ $$aCahill, Daniel P$$b28
000306605 7001_ $$aHuang, Raymond Y$$b29
000306605 7001_ $$aRaabe, Andreas$$b30
000306605 7001_ $$aMeyer, Bernhard$$b31
000306605 7001_ $$aBeck, Juergen$$b32
000306605 7001_ $$aMolinaro, Annette M$$b33
000306605 7001_ $$aChang, Susan M$$b34
000306605 7001_ $$aVogelbaum, Michael A$$b35
000306605 7001_ $$aRudà, Roberta$$b36
000306605 7001_ $$aVik-Mo, Einar O$$b37
000306605 7001_ $$aDietrich, Jorg$$b38
000306605 7001_ $$aEsquenazi, Yoshua$$b39
000306605 7001_ $$aGrau, Stefan J$$b40
000306605 7001_ $$aWen, Patrick Y$$b41
000306605 7001_ $$aJakola, Asgeir S$$b42
000306605 7001_ $$aSchnell, Oliver$$b43
000306605 7001_ $$aBello, Lorenzo$$b44
000306605 7001_ $$avan den Bent, Martin J$$b45
000306605 7001_ $$aHervey-Jumper, Shawn$$b46
000306605 7001_ $$aBerger, Mitchel S$$b47
000306605 7001_ $$aTonn, Joerg-Christian$$b48
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