BACKGROUND Few studies use large, multi-institutional patient cohorts to examine the role of intraoperative magnetic resonance imaging (iMRI) in the resection of grade II gliomas. OBJECTIVE To assess the impact of iMRI and other factors on overall survival (OS) and progression-free survival (PFS) for newly diagnosed grade II astrocytomas and oligodendrogliomas. METHODS Retrospective analyses of a multicenter database assessed the impact of patient-, treatment-, and tumor-related factors on OS and PFS. RESULTS A total of 232 resections (112 astrocytomas and 120 oligodendrogliomas) were analyzed. Oligodendrogliomas had longer OS (P < .001) and PFS (P = .01) than astrocytomas. Multivariate analyses demonstrated improved OS for gross total resection (GTR) vs subtotal resection (STR; P = .006, hazard ratio [HR]: .23) and near total resection (NTR; P = .02, HR: .64). GTR vs STR (P = .02, HR: .54), GTR vs NTR (P = .04, HR: .49), and iMRI use (P = .02, HR: .54) were associated with longer PFS. Frontal (P = .048, HR: 2.11) and occipital/parietal (P = .003, HR: 3.59) locations were associated with shorter PFS (vs temporal). Kaplan-Meier analyses showed longer OS with increasing extent of surgical resection (EOR) (P = .03) and 1p/19q gene deletions (P = .02). PFS improved with increasing EOR (P = .01), GTR vs NTR (P = .02), and resections above STR (P = .04). Factors influencing adjuvant treatment (35.3% of patients) included age (P = .002, odds ratio [OR]: 1.04) and EOR (P = .003, OR: .39) but not glioma subtype or location. Additional tumor resection after iMRI was performed in 105/159 (66%) iMRI cases, yielding GTR in 54.5% of these instances. CONCLUSION EOR is a major determinant of OS and PFS for patients with grade II astrocytomas and oligodendrogliomas. Intraoperative MRI may improve EOR and was associated with increased PFS.

中文翻译：

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术中磁共振成像和其他因素对新诊断的 II 级星形细胞瘤和少突胶质细胞瘤手术结果的影响：一项多中心研究

背景 很少有研究使用大型、多机构患者队列来检查术中磁共振成像 (iMRI) 在切除 II 级胶质瘤中的作用。目的 评估 iMRI 和其他因素对新诊断的 II 级星形细胞瘤和少突胶质细胞瘤的总生存 (OS) 和无进展生存 (PFS) 的影响。方法 对多中心数据库的回顾性分析评估了患者、治疗和肿瘤相关因素对 OS 和 PFS 的影响。结果 共分析了 232 个切除（112 个星形细胞瘤和 120 个少突胶质细胞瘤）。少突胶质细胞瘤比星形细胞瘤具有更长的 OS (P < .001) 和 PFS (P = .01)。多变量分析表明，大体全切除 (GTR) 与次全切除 (STR；P = .006，风险比 [HR]：0.23) 和接近全切除 (NTR；P = .02，HR：0.64）。GTR 与 STR（P = .02，HR：.54）、GTR 与 NTR（P = .04，HR：.49）和 iMRI 使用（P = .02，HR：.54）与更长的 PFS 相关。额叶（P = .048，HR：2.11）和枕骨/顶叶（P = .003，HR：3.59）位置与较短的 PFS（与颞叶相比）相关。Kaplan-Meier 分析显示，随着手术切除 (EOR) (P = .03) 和 1p/19q 基因缺失 (P = .02) 范围的增加，OS 更长。PFS 随着 EOR (P = .01)、GTR 与 NTR (P = .02) 以及高于 STR 的切除术 (P = .04) 的增加而改善。影响辅助治疗的因素（35.3% 的患者）包括年龄（P = .002，优势比 [OR]：1.04）和 EOR（P = .003，OR：0.39），但不包括胶质瘤亚型或位置。105/159 (66%) 例 iMRI 病例在 iMRI 后进行了额外的肿瘤切除，其中 54.5% 的病例获得 GTR。结论 EOR 是 II 级星形细胞瘤和少突胶质细胞瘤患者 OS 和 PFS 的主要决定因素。术中 MRI 可能会改善 EOR，并与 PFS 增加相关。