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Multicenter Study
. 2025 May;15(5):e70510.
doi: 10.1002/brb3.70510.

Risk Factors and Prognostic Implications of Tumor-Related Epilepsy in Diffuse Glioma Patients: A Real-World Multicenter Study

Yao Xiao  1   2   3 , Zhuang Nie  1   2   3 , Jinsha Huang  4 , Jie Zhao  1   2   3 , Chengjun Dong  1   2   3 , Yan Zou  1   2   3 , Zikai Li  5 , Bingqing Yan  1   2   3 , Yue Hu  6 , Fan Yang  1   2   3 , Jong Woo Lee  7 , Alexander P Lin  8 , Steven Tobochnik  7 , Min Zhou  1   2   3 , Ziqiao Lei  1   2   3
Affiliations
Multicenter Study

Risk Factors and Prognostic Implications of Tumor-Related Epilepsy in Diffuse Glioma Patients: A Real-World Multicenter Study

Yao Xiao et al. Brain Behav. 2025 May.

Abstract

Purpose: The relevance of tumor-related epilepsy (TRE) to glioma survival is controversial. This study aimed to assess the risk factors and prognostic impact of TRE in adult patients with diffuse gliomas by integrating clinical, radiological, and molecular data.

Methods: This multicenter retrospective study included 1036 adult patients with diffuse gliomas from local hospitals and the POLA Network. Patients were categorized into three prognostic groups: lower-grade oligodendroglioma/astrocytoma (OD/AC, II-III, IDH-MT), not otherwise specified or not elsewhere classified (NOS/NEC, II-III, IDH-WT), and high-grade gliomas (HGG, IV). Clinico-radiological, molecular, and therapeutic factors were analyzed using univariate and multivariate logistic regression, with the Cox proportional hazards model applied to identify independent prognostic factors for progression-free survival (PFS) and overall survival (OS).

Results: TRE occurred in 44.4% of OD/AC patients, 25.8% of NOS/NEC patients, and 16.5% of HGG patients. Multivariate analysis identified age as the only significant independent correlate of TRE in the OD/AC group (OR = 0.961; p = 0.004), while the absence of deep structure involvement was independently associated with TRE in the NOS/NEC and HGG groups. In univariate analysis, the presence of TRE was associated with longer PFS and OS across all groups, particularly in the NOS/NEC group, where patients with TRE had a median PFS of 35.2 months compared to 13.6 months in those without TRE (p = 0.02), but was not a significant predictor in multivariate analyses. TRE was the only factor significantly associated with maintaining histological grade at recurrence (HR = 0.094; p = 0.005).

Conclusion: TRE was not a strong independent prognostic factor after controlling for clinical and molecular tumor features, suggesting that the prognostic relevance of TRE is likely driven by underlying glioma biology and other associated clinical factors.

Keywords: OS; PFS; adult diffuse gliomas; epilepsy; tumor extension.

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Conflict of interest statement

The authors have no conflict of interest. None of the authors is current Editor or Editorial Board Member.

Figures

FIGURE 1
FIGURE 1
The inclusion and exclusion flowchart. OD/AC: oligodendroglioma/astrocytoma, grade II–III, IDH‐MT; NOS/NEC: not otherwise specified or not elsewhere classified, grade II–III, IDH‐WT; HGG: high‐grade gliomas, grade IV.
FIGURE 2
FIGURE 2
Progression‐free survival (A) and overall survival (B) according to gliomas patients with tumor‐related epilepsy (TRE) and non‐TRE in OD/AC, NOS/NEC and HGG groups. OD/AC: oligodendroglioma/astrocytoma, grade II–III, IDH‐MT; NOS/NEC: not otherwise specified or not elsewhere classified, grade II–III, IDH‐WT; HGG: high‐grade gliomas, grade IV.
FIGURE 3
FIGURE 3
Forest plot illustrating the PFS and OS of univariate survival analyses for the OD/AC (A), NOS/NEC (B), and HGG (C) groups. Deep structures: either corpus callosum, basal ganglia or brainstem; OD/AC: oligodendroglioma/astrocytoma, grade II–III, IDH‐MT; NOS/NEC: not otherwise specified or not elsewhere classified, grade II–III, IDH‐WT; HGG: high‐grade gliomas, grade IV; PFS: progression‐free survival; OS: overall survival; NA: data on subgroup occurrence outcomes were insufficient to calculate median survival.
See this image and copyright information in PMC

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