Low-grade gliomas in older patients: a matched propensity-scoring analysis to determine seizure outcomes and prognosis

AIMS Low-grade gliomas (LGG) are associated with significant morbidity and age is assumed to be a negative prognostic factor. The aim of this study was to compare outcomes between older patients with LGGs and a matched cohort of younger patients. METHOD Retrospective review of WHO grade II LGGs from 2009-2022. Propensity-score matching (1:3 matching) was used to compare older (≥65 years old) and matched younger controls (<65 years old). The two groups were matched by age, gender, presenting seizures, Karnofsky performance status, location, extent of resection, use of awake neurosurgical monitoring, histology subtype and post-operative chemoradiotherapy. Survival analysis was performed using Kaplan-Meier survival curves and log-rank test. RESULTS 40 patients were included - 10 older and 30 young. The median age was 70.0 and 48.5 years, respectively, with no differences in other demographic variables. Following resection, the older group had a shorter seizure-free period (median 2.5 vs. 10.9 months) and worse 1-year seizure-free rates (25.0% vs. 50.0%). Other outcomes were also worse in the older group including a shorter overall survival (median 95.0 vs. 117.0 months) and shorter progression-free survival (median 24.0 vs. 61.0 months). CONCLUSIONS In this novel study, we present the first matched analysis to evaluate outcomes in older patients with LGGs. We report worse seizure outcomes, overall survival and progression-free survival in these patients. Larger longitudinal multicentre studies will more accurately assess post-operative seizure-control and prognostic outcomes in between these groups.