Preoperative prognostic classification system for hemispheric low-grade gliomas in adults: Clinical article

Edward F. Chang, Justin S. Smith, Susan M. Chang, Kathleen R. Lamborn, Michael D. Prados, Nicholas Butowski, Nicholas M. Barbaro, Andrew T. Parsa, Mitchel S. Berger, Michael M. McDermott

Research output: Contribution to journalArticlepeer-review

164 Scopus citations


Object. Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs. Methods. The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system. Results. The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71-10.42), Karnofsky Performance Scale score ≤ 80 (HR 3.53, 95% CI 1.56-8.00), patient age > 50 years (HR 1.96, 95% CI 1.47-3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43-8.06). A scoring system calculated from the sum of these factors (range 0-4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0-1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3-4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described. Conclusions. The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.

Original languageEnglish (US)
Pages (from-to)817-824
Number of pages8
JournalJournal of neurosurgery
Issue number5
StatePublished - Nov 1 2008


  • Extent of resection
  • Low-grade glioma
  • Prognosis
  • Progression
  • Scoring
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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