Adult Diffuse Low-Grade Gliomas: 35-Year Experience at the Nancy France Neurooncology Unit

Abstract

Background: To report survival, spontaneous prognostic factors, and treatment efficacy in a French monocentric cohort of diffuse low-grade glioma (DLGG) patients over 35 years of follow-up.Methods: A monocentric retrospective study of 339 patients diagnosed with a new DLGG between 01/01/1982 and 01/01/2017 was created. Inclusion criteria were patient age ≥18 years at diagnosis and histological diagnosis of WHO grade II glioma (according to 1993(according to , 2007(according to , and 2016. The survival parameters were estimated using the Kaplan-Meier method with a 95% confidence interval. Differences in survival were tested for statistical significance by the log-rank test. Factors were considered significant when p ≤ 0.1 and p ≤ 0.05 in the univariate and multivariate analyses, respectively.Results: A total of 339 patients were included with a median follow-up of 8.7 years. The Kaplan-Meier median overall survival was 15.7 years. At the time of radiological diagnosis, Karnofsky Performance Status score and initial tumor volume were significant independent prognostic factors. Oncological prognostic factors were the extent of resection for patients who underwent surgery and the timing of radiotherapy for those concerned. In this study, patients who had delayed radiotherapy (provided remaining low grade) did not have worse survival compared with patients who had early radiotherapy.

Construction of a SUMOylation regulator‐based prognostic model in low‐grade glioma

“…The treatment of LGG is a comprehensive treatment based on maximum surgical resection, but progression of deterioration is still inevitable, and patients often have adverse outcomes such as multicentre recurrence and meningeal dissemination 10‐12 . SUMOylation, as a covalent modification, occurs mainly in lysine residues 13 and plays an important role in maintaining protein stability and stress response 14 .…”

Dynamic Interplay between Lower-Grade Glioma Instability and Brain Metaplasticity: Proposal of an Original Model to Guide the Therapeutic Strategy

“…Indeed, postoperative residual lesion infiltration has been linked to the degree of disconnection of WM pathways, e.g., by showing a deterioration of theory of mind (empathy) related to the degree of tumor involvement of the right frontoparietal connectivity (arcuate fasciculus and cingulum) [ 49 ], or lexical retrieval worsening related to postsurgical residual glioma volume within the left inferior longitudinal fasciculus [ 50 ]. Another argument pleading in favor of earlier treatment is to prevent malignant transformation, not only for oncological purposes, since the initial glioma volume is correlated to the risk of degeneration and to survival [ 51 ], but also for functional reasons. As previously mentioned, the potential of neural redistribution is less in rapid-growing lesions (variable t-), explaining the higher rate of neurological disorders in high-grade glioma [ 20 ].…”

What Does Quality of Care Mean in Lower-Grade Glioma Patients: A Precision Molecular-Based Management of the Tumor or an Individualized Medicine Centered on Patient’s Choices?

“…The ultimate aim should be to use the good treatment(s) at the optimal moment(s) according not only to the tumor genetics but also other prognostic parameters and patient’s expectations over time. Remarkably, recent series showed that applying this concept led to OS over 16 to 17 years while preserving the QoL for over one decade ( 10 , 11 ).…”

“…Twenty years later, it is now admitted that (i) beyond seizures, LGG patients suffer from cognitive and behavioral deficits at diagnosis even in incidental cases (4) (ii) this tumor will inescapably transform in higher grades, explaining the use of "lower-grade glioma" (mixing II/III) expression (5) (iii) early surgery is a main therapeutic factor (significant correlation between extent of resection and OS) (6, 7) (iv) early radiotherapy, at least given alone, is not associated with decreased mortality (6,8). These changes resulted in a longer life expectancy now over 15 to 16 years (9)(10)(11).…”