Introduction
Materials and methods
Patient data acquisition
Entire cohort | Surgical resection | Biopsy | |||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | p | |
Patients | 55 | 100 | 25 | 45.5 | 30 | 54.5 | - |
Gender | |||||||
Female | 21 | 38.2 | 10 | 40 | 11 | 36.7 | 0.82 |
Male | 34 | 61.8 | 15 | 60 | 19 | 63.3 | 0.82 |
Age in years | |||||||
Median (IQR) | 66 | (57.5–73) | 62.3 | (50.5–66.9) | 68.5 | (62.1–76) | - |
Symptomatic at first presentation | |||||||
Memory impairment | 15 | 27.3 | 3 | 12 | 12 | 40 | 0.02 |
Confusion/mental status alteration | 38 | 69 | 17 | 68 | 21 | 70 | 0.87 |
Visual field deficit | 6 | 11 | 4 | 16 | 2 | 6.7 | 0.27 |
Aphasia | 10 | 18.2 | 7 | 28 | 3 | 10 | 0.08 |
Cranial nerve impairment | 2 | 3.6 | 1 | 4 | 1 | 3.3 | 0.89 |
Motor function impairment | 13 | 23.6 | 7 | 28 | 6 | 20 | 0.49 |
Sensory function impairment | 3 | 5.5 | 1 | 4 | 2 | 6.7 | 0.66 |
Psychiatric alteration | 1 | 1.8 | 0 | - | 1 | 3.3 | 0.36 |
Headache | 7 | 12.7 | 6 | 24 | 1 | 3.3 | 0.01 |
Epilepsy | 11 | 20 | 3 | 12 | 8 | 26.7 | 0.20 |
Histopathological and molecular diagnostics
MR imaging acquisition
Tumor segmentation
Surgical treatment
Oncological treatment
Primary endpoint
Statistical analysis
Results
Patients’ demographics
Characteristics of the biopsy and resection cohorts
Entire cohort | Surgical resection | Biopsy | |||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | p | |
Patients | 55 | 100 | 25 | 45.5 | 30 | 54.5 | - |
Site of CC invasion | |||||||
Rostrum | 1 | 1.8 | 0 | 0 | 1 | 3.3 | 0.36 |
Genu | 26 | 47.2 | 17 | 68 | 9 | 30 | 0.005 |
Genu/body | 5 | 9 | 2 | 8 | 3 | 10 | 0.79 |
Body | 11 | 20 | 3 | 12 | 8 | 26.7 | 0.18 |
Body/splenium | 6 | 11 | 1 | 4 | 5 | 16.7 | 0.13 |
Splenium | 6 | 11 | 2 | 8 | 4 | 13.3 | 0.53 |
Surgery | |||||||
GTR | 8 | 14.55 | |||||
PR | 17 | 30.9 | |||||
Biopsy | 30 | 54.55 | |||||
Tumor volume in cm3 | |||||||
Preoperative median | 43.5 | 59.4 | 35.2 | 0.01 | |||
Postoperative median | 5.96 | 5.96 | 35.2 | * | |||
Complication | |||||||
None | 42 | 76.3 | 17 | 68 | 25 | 83.3 | 0.18 |
Hemorrhage | 3 | 5.4 | 3 | 12 | 0 | 0 | 0.05 |
Ischemia | 1 | 1.8 | 1 | 4 | 0 | 0 | 0.27 |
Cranial nerve deficit | 1 | 1.8 | 1 | 4 | 0 | 0 | 0.27 |
Meningitis | 2 | 3.6 | 2 | 8 | 0 | 0 | 0.84 |
Hydrocephalus | 3 | 5.4 | 1 | 4 | 2 | 6.7 | 0.81 |
Aphasia | 3 | 5.4 | 1 | 4 | 2 | 6.7 | < 0.001 |
Pneumonia | 1 | 1.8 | 0 | 0 | 1 | 3.3 | 0.89 |
Follow-up outcome
Entire cohort | Surgical resection | Biopsy | |||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | p | |
Patients | 55 | 100 | 25 | 45.5 | 30 | 54.5 | - |
Adjuvant treatment | |||||||
RCT | 16 | 29.1 | 7 | 28 | 9 | 30 | 0.87 |
CT | 13 | 23.4 | 7 | 28 | 6 | 20 | 0.49 |
RT | 3 | 5.5 | 3 | 12 | 0 | 0 | 0.05 |
Palliative | 23 | 41.8 | 8 | 32 | 15 | 50 | - |
MGMT-promoter status | |||||||
Methylated | 15 | 27.3 | 4 | 16 | 11 | 36.6 | 0.09 |
Unmethylated | 15 | 27.3 | 9 | 36 | 6 | 20 | 0.18 |
NA | 25 | 45.4 | 12 | 48 | 13 | 43.4 | - |
Entire cohort | Surgical Resection | Biopsy | |||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | p | |
Patients | 55 | 100 | 25 | 45.5 | 30 | 54.5 | - |
Preoperative | |||||||
100 | 0 | - | 0 | - | 0 | - | - |
90 | 17 | 30.9 | 10 | 40 | 7 | 23.3 | 0.18 |
80 | 23 | 41.8 | 8 | 32 | 15 | 50 | 0.18 |
< 80 | 15 | 27.3 | 7 | 28 | 8 | 26.7 | 0.91 |
Postoperative | |||||||
100 | 13 | 23.6 | 9 | 36 | 4 | 13.3 | 0.05 |
90 | 22 | 40 | 8 | 32 | 14 | 46.7 | 0.27 |
80 | 6 | 10.9 | 4 | 16 | 2 | 6.7 | 0.27 |
< 80 | 14 | 25.5 | 4 | 16 | 10 | 33.3 | 0.14 |
3-month follow-up | |||||||
100 | 5 | 9.1 | 4 | 16 | 1 | 3.33 | 0.10 |
90 | 7 | 12.7 | 3 | 12 | 4 | 13.33 | 0.88 |
80 | 6 | 10.9 | 2 | 8 | 4 | 13.33 | 0.53 |
< 80 | 12 | 21.8 | 7 | 28 | 5 | 16.7 | 0.31 |
0 | 25 | 45.5 | - | - | - | - | - |
12-month follow-up | |||||||
100 | 4 | 7.3 | 2 | 8 | 2 | 6.7 | 0.85 |
90 | 1 | 1.8 | 1 | 4 | 0 | - | 0.27 |
80 | 0 | - | - | - | - | - | - |
< 80 | 10 | 18.2 | 7 | 28 | 3 | 10 | 0.08 |
0 | 40 | 72.7 | - | - | - | - | - |
Surgical complications
Outcome analysis of biopsy vs. resection
Entire cohort | Surgical resection | Biopsy | |||||
---|---|---|---|---|---|---|---|
N | % | N | % | N | % | p | |
Patients | 55 | 100 | 25 | 45.5 | 30 | 54.5 | - |
Median OS (CI 95%) | 252 (123–513) | 258 (153–413) | 220 (244–NA) | 0.041 | |||
Median PFS | 153 | 146 | 154 | ||||
3-month survival | 42 | 76 | 21 | 84 | 21 | 78 | n.s. |
6-month survival | 32 | 58 | 16 | 67 | 16 | 59 | n.s. |
12-month survival | 21 | 38 | 12 | 58 | 9 | 33 | 0.032 |
24-month survival | 5 | 9 | 3 | 30 | 2 | 7 | 0.047 |
Multivariate Cox regression | |||
---|---|---|---|
HR | CI 95% | p value | |
Surgical treatment | |||
Biopsy | * | ||
GTR | 0.35 | 0.13–0.93 | 0.036 |
PR | 0.76 | 0.38–1-52 | 0.431 |
Adjuvant treatment | |||
CT | * | ||
Palliative | 2.77 | 1.20–6.39 | 0.017 |
RCT | 0.81 | 0.34–1.93 | 0.629 |
RT | 1.57 | 0.31–7.91 | 0.586 |
Anatomy | |||
Genu | * | ||
Splenium | 0.41 | 0.12–1.42 | 0.160 |
Sex | |||
Male | * | ||
Female | 1.00 | 0.53–1.90 | 0.997 |
Epilepsy | 0.70 | 0.33–1.51 | 0.369 |
Age | |||
Continuous variable | 1.05 | 1.01–1.08 | 0.013 |
KPS | |||
Ordinal variable | 0.99 | 0.96–1.02 | 0.396 |