The benefit of early surgery on overall survival in incidental low-grade glioma patients: A multicenter study

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Abstract
The role of surgery for incidentally discovered diffuse low-grade gliomas (iLGGs) is debatable and poorly documented in current literature. The aim was to identify factors that influence survival for patients that underwent surgical resection of iLGGs in a large multicenter population. Clinical, radiological, and surgical data were retrospectively analyzed in 267 patients operated for iLGG from 4 neurosurgical Centers. Univariate and multivariate analyses were performed to identify predictors of overall survival (OS) and tumor recurrence (TR). The OS rate was 92.41%. The 5- and 10-year estimated OS rates were 98.09% and 93.2% respectively. OS was significantly longer for patients with a lower preoperative tumor volume (p=0.001) and higher extent of resection (EOR) (p=0.037), regardless the WHO defined molecular class (p=0.2). In the final model, OS was influenced only by the preoperative tumor volume (p=0.006), while TR by early surgery (p=0.028). A negative association was found between preoperative tumor volumes and EOR (rs = -0.44, p3. The median EOR was 95%. Total or supratotal resection of FLAIR abnormality was achieved in 61.62% of cases. Second surgery was performed in 26.22%. The median time between surgeries was 5.5 years. Histological evolution to high grade glioma was detected in 22.85% of cases (16/70). Permanent mild deficits were observed in 3.08% of cases. This multicenter study confirms the results of previous studies investigating surgical management of iLGGs and thereby strengthens the evidence in favour of early surgery for these lesions.

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