Extent of reoperation predicts survival in recurrent IDH-wildtype glioblastoma based on institutional data and individual patient data meta analysis
Year: 2025
Type: article
Study design: Systematic Review
Abstract: Background Glioblastoma (GB) is the most aggressive brain tumor, characterized by rapid progression and poor prognosis. Despite initial multimodal treatment options, therapeutic options become more limited upon recurrence. Consequently, recurrent IDH-wildtype GB is associated with poor survival outcomes, with limited data to guide optimal therapeutic strategies. This study presents the largest meta-analysis to date, pooling institutional data with individual patient data (IPD), addressing progression-free survival (PFS) and overall survival (OS) from timepoint after re-resection. Methods Institutional data and data from literature (2016–2024) were analyzed to evaluate PFS and OS in relation to the extent of resection (EoR). Survival data from identified studies were extracted from Kaplan-Meier curves with the R package IPDfromKM. Additionally, a retrospective analysis of institutional data was conducted, assessing for PFS and OS in 53 patients. EoR was dichotomized as suggested by the RANO group into residual contrast-enhancing tumor volume (CE-RTV) ≤ 1 cm 3 or > 1cm 3 . Results A total of 442 IPD were included in this meta-analysis. Among them, 331 patients (74.9%) underwent neurosurgical treatment with CE-RTV ≤ 1cm 3 , while 111 patients (25.1%) had CE-RTV > 1 cm 3 . Pooled analysis indicated a significant reduction in OS after re-resection with CE-RTV > 1 cm 3 compared to CE-RTV ≤ 1cm 3 (HR: 1.731, 95% confidence interval (CI): 1.342–2.234, p < 0.0001). While re-resection with CE-RTV ≤ 1cm 3 was associated with longer OS (14.4 months) compared to CE-RTV > 1 cm 3 (8.8 months) ( p < 0.0001), PFS did not differ between the two groups (CE-RTV ≤ 1 cm 3 : 7.2 months compared to CE-RTV > 1cm 3 : 5.8 months) ( p = 0.76). Conclusion Across pooled IPD, maximal safe resection at re-resection operationalized as GTR or RANO class 1 and 2 was significantly associated with longer overall survival (OS). Where volumetric assessment is available, achieving a postoperative CE-RTV ≤ 1 cm 3 may be a reasonable pragmatic target, however this threshold was not directly measured in all included cohorts and should be interpreted as hypothesis-generating. Graphical abstract
Source: Discover Oncology
Authors: Alim Emre Basaran, Ann-Catalin Wellkisch, Erdem Güresir, Johannes Wach
Institutions: University Hospital Leipzig, Leipzig University
Language: English
Subfield: Genetics
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,690
OpenAlex ID: W4416187281