A Permanent but Not Transient Postoperative Deficit Has Impact on OS and PFS in IDHwt-Glioma Patients
TL;DR
Temporary neurological deterioration following glioma surgery does not appear to adversely influence overall or progression-free survival, regardless of IDH status, however, persistent postoperative deficits, as well as newly acquired deficits that remain evident during follow-up, are strong indicators of an unfavorable prognosis in patients with IDH-wild-type gliomas.
Abstract
Background/Objectives: Neurological impairment after glioma resection is a common postoperative event, but many deficits improve during recovery. The present study investigated whether transient and persistent postoperative neurological deficits differ in their association with overall survival (OS) and progression-free survival (PFS). Methods: We retrospectively reviewed data from patients who underwent initial surgical treatment for glioma in our institution. Neurological function was evaluated using documented clinical examinations performed before surgery, in the immediate postoperative period, and during routine follow-up 3–6 months after the procedure. Results: The study cohort comprised 496 patients, of whom 44.4% were women. The mean age at surgery was 60 years (95% CI, 58–61), and the average follow-up period was 21 months (95% CI, 19–23). According to the 2021 WHO classification, 80.0% of tumors were grade 4, 11.1% were grade 3, and 7.3% were grade 2. IDH mutations were absent in 81% of cases. Median survival for the entire cohort was 34 months (95% CI, 30–38). Preoperative neurological deficits, including hemiparesis, were not significantly associated with OS. Postoperative deficits that were resolved by the follow-up assessment showed no relationship with either OS or PFS, irrespective of IDH mutation status. In contrast, neurological deficits that persisted at follow-up were independently associated with shorter OS and PFS among patients with IDH-wild-type gliomas (p < 0.001), whereas no significant association was observed in the IDH-mutant subgroup. Similarly, when new neurological deficits were present at follow-up, poorer OS and PFS were predicted only in patients with IDH-wild-type tumors (p < 0.001). Conclusions: Temporary neurological deterioration following glioma surgery does not appear to adversely influence overall or progression-free survival, regardless of IDH status. However, persistent postoperative deficits, as well as newly acquired deficits that remain evident during follow-up, are strong indicators of an unfavorable prognosis in patients with IDH-wild-type gliomas.