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. 2025 Aug 19;7(1):vdaf138.
doi: 10.1093/noajnl/vdaf138. eCollection 2025 Jan-Dec.

Is tumor shape associated with molecular diagnosis, extent of resection, or postoperative focal deficits in diffuse low-grade gliomas?

Claes Johnstad  1 , Ingerid Reinertsen  2   3 , Alba Corell  4 , Erik Thurin  5   6 , Tora Dunås  5 , Margret Jensdottir  7   8 , Jiri Bartek  9   7   8 , Klas Holmgren  10 , Rickard L Sjöberg  10 , Francesco Latini  11 , Maria Zetterling  11 , Rupavathana Mahesparan  12   13 , Peter Milos  14   15   16 , Björn Sjögren  14   15   16 , Henrietta Nittby Redebrandt  17 , Gregor Tomasevic  17 , Lars Kjelsberg Pedersen  17 , Asgeir S Jakola  18   4 , Ole Solheim  18   4   1
Affiliations

Is tumor shape associated with molecular diagnosis, extent of resection, or postoperative focal deficits in diffuse low-grade gliomas?

Claes Johnstad et al. Neurooncol Adv. .

Abstract

Background: This study aimed to explore the potential association between tumor shape, 1p/19q codeletion, EOR, and new postoperative focal deficits in patients with diffuse low-grade glioma.

Methods: We analyzed data from 225 WHO grade 2 glioma surgeries performed in nine centers in Norway and Sweden. The tumor measurements were based on automatic segmentations of preoperative T2/FLAIR MRI scans by Raidionics. Contact surface area (CSA) was defined as the area between the tumor and brain parenchyma and was estimated by subtracting the surface area covered by the dura from the total surface area. The sphericity index (SI) was defined as the quotient of the tumor surface area and the surface area of a sphere with equal volume. Focal deficits were defined as any new motor, language, or visual deficits postoperatively.

Results: The univariable analyses showed that a larger CSA was associated with higher age (P = .02), lower EOR (P < .0001), and more focal deficits (P = .005) but not with 1p/19q codeletion (P = .54). A higher SI was associated with higher age (P = .02) and lower EOR (P < .0001) but not with focal deficits (P = .08) or 1p/19q codeletion (P = .90). The multivariable linear regression model supported the univariable associations between EOR and CSA (P = .0003) and SI (P = .0013), respectively. Contrarily, the logistic regression model showed that focal deficits were associated with SI (P = .014) but not with CSA (P = .056).

Conclusion: The tumor shape appears to be independently associated with EOR and new focal deficits but not with molecular diagnosis in patients with low-grade glioma.

Keywords: LGG; sphericity index; tumor shape; tumor size; tumor surface area.

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Figures

Figure 1.
Figure 1.
Illustration of the calculation of CSA. This example shows the segmentation of a tumor (A); the dura mater in contact with the tumor (B); and the two segmentations combined (C). The formula shows the calculation of CSA by subtraction of the surface area between the tumor and dura mater from the total tumor surface area. The letters A, B, and C in the formula represent the surface areas of their respective segmentations. In a subcortical tumor, B would be 0, and C would be equal to A, and thus, the CSA would be equal to A. CSA: contact surface area.
Figure 2.
Figure 2.
Flowchart of the inclusion process. LGG: low-grade glioma; IDH: isocitrate dehydrogenase; FLAIR: fluid-attenuated inversion recovery.
Figure 3.
Figure 3.
Boxplot showing CSA and SI among different EOR groups. STR is grouped by tertiles with n = 49 for each box, whereas GTR is represented by its own box with n = 51. EOR range for the STR tertiles is displayed below the respective boxes. The EOR was categorized in this plot for illustrative purposes, but it was otherwise analyzed as a continuous variable. EOR: extent of resection; CSA: contact surface area; SI: sphericity index; STR: subtotal resection; GTR: gross total resection.
See this image and copyright information in PMC

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