Which specific neurological tests provide the greatest value in predicting prognosis in awake-surgery glioma patients

Abstract

Background: Diffuse gliomas have a variable survival outcome with prognosis relying on established predictors. Cognition is shown to have added value in these predictions. This retrospective cohort study aims to uncover the added value of individual neuropsychological tests (NPTs) in the prediction of survival outcome in glioma patients undergoing awake brain surgery. Methods: In this retrospective cohort study, we included patients undergoing awake craniotomy with extensive neuropsychological assessment (NPA) between 2019 and. The added prognostic value of these NPTs was determined in two patient groups based on isocitrate dehydrogenase-wild type (IDH-WT) or isocitrate dehydrogenase mutation (IDH-M). We compared Cox proportional hazards regression models with and without the NPTs using loglikelihood ratios tests (LRT), discriminative performance measures (Harrell’s c-statistic), and risk classification by Integrated Discrimination Index (IDI). Results: This study included 178 IDH-WT patients and 148 IDH-M patients with a median survival time of 2025.0 and 503.0 days, respectively. The RAVLT-Dutch Version (15WT) immediate and the 15WT recall tests proved to have added prognostic value in the IDH-WT cohort. In the IDH-M cohort, the NPTs 15WT immediate, phonologic fluency and semantic fluency had significant added prognostic value, with a combination of these three being the best predictor. Conclusions: In conclusion, our research demonstrates that NPTs provide added prognostic value for treatment-naive patients with diffuse gliomas, when integrated with established predictors. These findings advocate for the implementation of these NPTs into prognostic models specifically made for this patient group.