# Long-term family outcomes in grade 2 IDH-mutated glioma patients treated with awake-guided surgery: Biological, professional, and therapeutic interactions

## TL;DR

This study examines how IDH-mutated low-grade glioma patients' family lives change over time after surgery, showing that most maintain stable family relationships despite the disease.

## Contribution

The study uniquely explores long-term family outcomes in IDH-mutated glioma patients, highlighting interactions between familial, professional, and oncological factors.

## Key findings

- Most patients maintained stable family status after surgery, with 74.2% showing no change.
- Total resection predicted new unions/marriages and parenthood, while right pars orbitalis/triangularis tumor infiltration was linked to separation/divorce.
- Family status did not affect overall survival, according to survival analyses.

## Abstract

Maintaining quality of life is a priority of the oncological management in IDH-mutated low-grade gliomas (IDHm-LGGs). Yet, family outcomes have received limited attention. This study aims to provide an overview of long-term family outcomes in IDHm-LGG patients.

We retrospectively studied a consecutive cohort of IDHm-LGGs treated with awake functional-based resection (AwFR). The main outcomes were union/marriage, separation/divorce, and parenthood before/after surgery. We tested interactions with overall survival (OS), histomolecular data, therapeutics, occupations, and tumor locations.

A total of 538 patients were included (median age: 36 years [IQR: 30–44], 1p19q-codeletion: 237 [44.1%], median follow-up: 7.7 years [95% CI: 7.1–8.3]). Unions/marriages were observed in 374 (69.5%) patients preoperatively and were maintained in 329(61.2%) patients. Separations/divorces were observed in 41 (7.8%) patients. A total of 44 (8.2%) patients had new child/children, and 48 (9.1%) had new unions/marriages. Family status was stable in 399 (74.2%) patients. Prolonged single status was predicted by age (OR: 0.94, 95% CI: 0.91–0.98), female gender (OR: 0.48, 95% CI: 0.25–0.91), and previous child/children (OR: 0.23, 95% CI: 0.11–0.45). Total resection predicted new union/marriage and/or new child/children (OR: 2.59, 95% CI: 1.04–7.10). Occupational skill level (OR: 0.27, 95% CI: 0.05–0.95) predicted stable union/marriage, while previous parenthood predicted separation/divorce (OR: 2.73, 95% CI: 1.07–7.83). Lesion-symptom mapping revealed that right pars orbitalis/triangularis infiltrations (Liebermeister measures, pcorrected < 0.05, 10 000 permutations) were associated with separation/divorce. Family status did not impact OS, as assessed by multivariable proportional hazard and propensity matching-based survival analyses.

This study offers a unique overview of the long-term family outcomes in IDHm-LGG patients. Critical interactions between familial, socio-professional, and oncological factors were highlighted. Despite the onset of the disease and the surgical approach, most patients had a stable family status.