Factors Involved in Preoperative Edema in High-Grade Gliomas

Takashi Saito; Masashi Mizumoto; Hsiang-Kuang Liang; Kei Nakai; Taisuke Sumiya; Takashi Iizumi; Hidehiro Kohzuki; Haruko Numajiri; Hirokazu Makishima; Takao Tsurubuchi; Masahide Matsuda; Eiichi Ishikawa; Hideyuki Sakurai

doi:10.7759/cureus.31379

Factors Involved in Preoperative Edema in High-Grade Gliomas

Cureus. 2022 Nov 11;14(11):e31379. doi: 10.7759/cureus.31379. eCollection 2022 Nov.

Affiliations

¹ Department of Radiation Oncology, University of Tsukuba Hospital, Tsukuba, JPN.
² Division of Radiation Oncology, National Taiwan University Hospital, Taipei, TWN.
³ Department of Neurosurgery, University of Tsukuba Hospital, Tsukuba, JPN.

Abstract

Background Expansion of preoperative edema (PE) is an independent poor prognostic factor in high-grade gliomas. Evaluation of PE provides important information that can be readily obtained from magnetic resonance imaging (MRI), but there are few reports on factors associated with PE. The goal of this study was to identify factors contributing to PE in Grade 3 (G3) and Grade 4 (G4) gliomas. Methodology PE was measured in 141 pathologically proven G3 and G4 gliomas, and factors with a potential relationship with PE were examined in univariate and multivariate analyses. The following eight explanatory variables were used: age, sex, Karnofsky performance status (KPS), location of the glioma, tumor diameter, pathological grade, isocitrate dehydrogenase (IDH)-1-R132H status, and Ki-67 index. Overall survival (OS) and progression-free survival (PFS) were calculated in groups divided by PE (<1 vs. ≥1 cm) and by factors with a significant correlation with PE in multivariate analysis. Results In univariate analysis, age (p = 0.013), KPS (p = 0.012), pathology grade (p = 0.004), and IDH1-R132H status (p = 0.0003) were significantly correlated with PE. In multivariate analysis, only IDH1-R132H status showed a significant correlation (p = 0.036), with a regression coefficient of -0.42. The median follow-up period in survivors was 38.9 months (range: 1.2-131.7 months). The one-, two-, and three-year OS rates for PE <1 vs. ≥1 cm were 77% vs. 68%, 67% vs. 44%, and 63% vs. 24% (p = 0.0001), respectively, and those for IDH1-R132H mutated vs. wild-type cases were 85% vs. 67%, 85% vs. 40%, and 81% vs. 21% (p < 0.0001), respectively. The one-, two-, and three-year PFS rates for PE <1 vs. ≥1 cm were 77% vs. 49%, 64% vs. 24%, and 50% vs. 18% (p = 0.0002), respectively, and those for IDH1-R132H mutated vs. wild-type cases were 85% vs. 48%, 77% vs. 23%, and 73% vs. 14% (p < 0.0001), respectively. Conclusions IDH1-R132H status was found to be a significant contributor to PE. Cases with PE <1 cm and those with the IDH1-R132H mutation clearly had a better prognosis.

Keywords: glioblastoma; glioma; isocitrate dehydrogenase; magnetic resonance imaging; preoperative edema; radiotherapy.