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@ARTICLE{Karschnia:306605,
      author       = {P. Karschnia and J. S. Young and M. M. J. Wijnenga and T.
                      Sciortino and N. Teske and A. Corell and A. Wagner and G.
                      Youssef and Y. W. Park and L. Häni and S. T. Jünger and A.
                      Dono and F. Ehret$^*$ and E. E. M. Mireles and N. Neidert
                      and F. Bruno and C. A. Tuchek and T. van der Vaart and M.
                      Rossi and M. C. Nibali and L. Gay and A. Gramelt and N.
                      Tandon and S. S. Ahn and J. H. Chang and M. Weller and A. J.
                      P. E. Vincent and R. Goldbrunner and D. P. Cahill and R. Y.
                      Huang and A. Raabe and B. Meyer and J. Beck and A. M.
                      Molinaro and S. M. Chang and M. A. Vogelbaum and R. Rudà
                      and E. O. Vik-Mo and J. Dietrich and Y. Esquenazi and S. J.
                      Grau and P. Y. Wen and A. S. Jakola and O. Schnell and L.
                      Bello and M. J. van den Bent and S. Hervey-Jumper and M. S.
                      Berger and J.-C. Tonn},
      title        = {{A} 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.},
      journal      = {The lancet / Oncology},
      volume       = {26},
      number       = {12},
      issn         = {1470-2045},
      address      = {London},
      publisher    = {The Lancet Publ. Group},
      reportid     = {DKFZ-2025-02642},
      pages        = {1638 - 1650},
      year         = {2025},
      abstract     = {The 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.},
      keywords     = {Humans / Middle Aged / Female / Isocitrate Dehydrogenase:
                      genetics / Male / Retrospective Studies / Adult / Brain
                      Neoplasms: surgery / Brain Neoplasms: genetics / Brain
                      Neoplasms: pathology / Brain Neoplasms: mortality / Brain
                      Neoplasms: classification / Mutation / Glioma: surgery /
                      Glioma: genetics / Glioma: pathology / Glioma: mortality /
                      Prognosis / Neoplasm Grading / Aged / Progression-Free
                      Survival / Young Adult / Neurosurgical Procedures: mortality
                      / Neoplasm, Residual / Isocitrate Dehydrogenase (NLM
                      Chemicals) / IDH2 protein, human (NLM Chemicals)},
      cin          = {BE01},
      ddc          = {610},
      cid          = {I:(DE-He78)BE01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:41308678},
      doi          = {10.1016/S1470-2045(25)00534-0},
      url          = {https://inrepo02.dkfz.de/record/306605},
}