Long-term radiological progression after resection of dysembryoplastic neuroepithelial tumors: patterns and prognostic factors

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. 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. 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%). 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.