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. 2020 Jul 10:10:1087.
doi: 10.3389/fonc.2020.01087. eCollection 2020.

The Association Between the Extent of Glioblastoma Resection and Survival in Light of MGMT Promoter Methylation in 326 Patients With Newly Diagnosed IDH-Wildtype Glioblastoma

Fatih Incekara  1   2 , Marion Smits  2 , Sebastian R van der Voort  2 , Hendrik Jan Dubbink  3 , Peggy N Atmodimedjo  3 , Johan M Kros  3 , Arnaud J P E Vincent  1 , Martin van den Bent  4
Affiliations

The Association Between the Extent of Glioblastoma Resection and Survival in Light of MGMT Promoter Methylation in 326 Patients With Newly Diagnosed IDH-Wildtype Glioblastoma

Fatih Incekara et al. Front Oncol. .

Abstract

Background: The association between contrast enhanced (CE) and non-contrast enhanced (NCE) tumor resection and survival in patients with glioblastoma in relation to molecular subtypes is poorly understood. The aim of this study was to assess the association between CE and NCE tumor resection and survival in light of MGMT promoter methylation in newly diagnosed IDH-wildtype glioblastoma. Materials and methods: Patients with newly diagnosed IDH-wildtype glioblastoma who underwent surgery were eligible. CE and NCE tumor volumes were assessed on pre- and post-operative MRI scans and extent of resection was calculated. The association between CE and NCE tumor resection and survival was evaluated using multivariable Cox proportional hazards models and Kaplan Meier estimates. Results: Three hundred and twenty-six patients were included: 177 (54.3%) with and 149 (45.7%) without MGMT methylation. Multivariable Cox proportional hazards models stratified for MGMT methylation identified age ≤ 65y (HR 0.63; 95% CI, 0.49-0.81; p < 0.0001), chemoradiation (HR 0.13; 95% CI, 0.09-0.19; p < 0.0001), maximal CE tumor resection (HR 0.58; 95% CI, 0.39-0.87; p = 0.009), ≥ 30% NCE tumor resection (HR 0.71; 95% CI, 0.53-0.93; p = 0.014), and minimal residual CE tumor volume (HR 0.64; 95% CI, 0.46-0.88 p = 0.007) as being associated with longer overall survival. Kaplan Meier estimates showed that extensive surgery was more beneficial for patients with MGMT methylated glioblastoma. Conclusions: This study shows an association between maximal CE tumor resection, ≥30% NCE tumor resection, minimal residual CE tumor volume, and longer overall survival in patients with newly diagnosed IDH wildtype glioblastoma. Intraoperative imaging and stimulation mapping may be used to pursue safe and maximal resection. In future research, the safety aspect of maximizing tumor resection needs to be addressed.

Keywords: MGMT; contrast enhanced; extent of resection; glioblastoma; non-contrast enhanced; survival.

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Figures

Figure 1
Figure 1
Overall and MGMT-stratified Kaplan Meier curves for overall survival (A) Maximal CE resection (B) NCE resection and (C) CE residual volume.
See this image and copyright information in PMC

References

    1. Stupp R, Mason WP, van Den Bent MJ, Weller M, Fisher B, Taphoorn MJB, et al. . Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. New Engl J Med. (2005) 352:987–96. 10.1056/NEJMoa043330 - DOI - PubMed
    1. Gessler F, Bernstock JD, Braczynski A, Lescher S, Baumgarten P, Harter PN, et al. . Surgery for glioblastoma in light of molecular markers: impact of resection and MGMT promoter methylation in newly diagnosed IDH-1 wild-type glioblastomas. Neurosurgery. (2019) 84:190–7. 10.1093/neuros/nyy049 - DOI - PMC - PubMed
    1. Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, et al. . Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. (2016) 2:1460–9. 10.1001/jamaoncol.2016.1373 - DOI - PMC - PubMed
    1. Eidel O, Burth S, Neumann JO, Kieslich PJ, Sahm F, Jungk C, et al. . Tumor infiltration in enhancing and non-enhancing parts of glioblastoma: a correlation with histopathology. PLoS One. (2017) 12:e0169292. 10.1371/journal.pone.0169292 - DOI - PMC - PubMed
    1. de Leeuw CN, Vogelbaum MA. Supratotal resection in glioma: a systematic review. Neuro Oncol. (2019) 21:179–88. 10.1093/neuonc/noy166 - DOI - PMC - PubMed