Long-term radiological progression after resection of dysembryoplastic neuroepithelial tumors: patterns and prognostic factors.
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PURPOSE: To characterize long-term radiological progression after resection of dysembryoplastic neuroepithelial tumors (DNETs) and identify prognostic factors, focusing on satellite lesions (SLs) and extent of resection. METHODS: We retrospectively reviewed 84 patients with pathologically confirmed DNETs who underwent surgery at a single institution. Tumor location and satellite lesions (SLs) were assessed on preoperative MRI. Tumor progression-free survival (PFS) was analyzed using Kaplan–Meier analysis with log‑rank tests and Cox regression, and seizure recurrence was compared using Fisher’s exact test. RESULTS: Over a median follow-up of 9.3 years, 24 patients (29%) demonstrated radiological progression. No progression occurred after gross total resection (GTR) (0/43), whereas 24/41 (59%) progressed after non-GTR (10-year PFS, 100% vs. 33.7%). SL-positive tumors showed higher progression than SL-negative tumors (44% vs. 10%) and remained independently associated with progression (hazard ratio [HR], 4.89; 95% CI, 1.57–15.23). Younger age at surgery and central lobe involvement were additional independent predictors. Seizure recurrence was more frequent in patients with radiological progression (67% vs. 20%). CONCLUSION: GTR provides excellent long‑term tumor control in DNET. When GTR is not achievable, SLs and central lobe involvement—particularly in younger patients—identify a high‑risk subgroup requiring maximal safe resection and close surveillance.