000306605 001__ 306605 000306605 005__ 20251129115931.0 000306605 0247_ $$2doi$$a10.1016/S1470-2045(25)00534-0 000306605 0247_ $$2pmid$$apmid:41308678 000306605 0247_ $$2ISSN$$a1470-2045 000306605 0247_ $$2ISSN$$a1474-5488 000306605 037__ $$aDKFZ-2025-02642 000306605 041__ $$aEnglish 000306605 082__ $$a610 000306605 1001_ $$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$$c2025 000306605 3367_ $$2DRIVER$$aarticle 000306605 3367_ $$2DataCite$$aOutput Types/Journal article 000306605 3367_ $$0PUB:(DE-HGF)16$$2PUB:(DE-HGF)$$aJournal Article$$bjournal$$mjournal$$s1764339028_98056 000306605 3367_ $$2BibTeX$$aARTICLE 000306605 3367_ $$2ORCID$$aJOURNAL_ARTICLE 000306605 3367_ $$00$$2EndNote$$aJournal Article 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. 000306605 536__ $$0G:(DE-HGF)POF4-899$$a899 - ohne Topic (POF4-899)$$cPOF4-899$$fPOF IV$$x0 000306605 588__ $$aDataset connected to CrossRef, PubMed, , Journals: inrepo02.dkfz.de 000306605 650_7 $$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 000306605 773__ $$0PERI:(DE-600)2035574-9$$a10.1016/S1470-2045(25)00534-0$$gVol. 26, no. 12, p. 1638 - 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