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. 2022 Feb 16:12:755430.
doi: 10.3389/fonc.2022.755430. eCollection 2022.

Complete and Incomplete Resection for Progressive Glioblastoma Prolongs Post-Progression Survival

Felix Behling  1   2 , Julia Rang  1 , Elena Dangel  1 , Susan Noell  1   2 , Mirjam Renovanz  1   2   3 , Irina Mäurer  2   3 , Jens Schittenhelm  2   4 , Benjamin Bender  2   5 , Frank Paulsen  6 , Bettina Brendel  7 , Peter Martus  7 , Jens Gempt  8 , Melanie Barz  8 , Bernhard Meyer  8 , Marcos Tatagiba  1   2   9 , Marco Skardelly  1   2
Affiliations

Complete and Incomplete Resection for Progressive Glioblastoma Prolongs Post-Progression Survival

Felix Behling et al. Front Oncol. .

Abstract

Objective: The role of resection in progressive glioblastoma (GBM) to prolong survival is still controversial. The aim of this study was to determine 1) the predictors of post-progression survival (PPS) in progressive GBM and 2) which subgroups of patients would benefit from recurrent resection.

Methods: We have conducted a retrospective bicentric cohort study on isocitrate dehydrogenase (IDH) wild-type GBM treated in our hospitals between 2006 and 2015. Kaplan-Maier analyses and univariable and multivariable Cox regressions were performed to identify predictors and their influence on PPS.

Results: Of 589 patients with progressive IDH wild-type GBM, 355 patients were included in analyses. Median PPS of all patients was 9 months (95% CI 8.0-10.0), with complete resection 12 months (95% CI 9.7-14.3, n=81), incomplete resection 11 months (95% CI 8.9-13.1, n=70) and without resection 7 months (95% CI 06-08, n=204). Multivariable Cox regression demonstrated a benefit for PPS with complete (HR 0.67, CI 0.49-0.90) and incomplete resection (HR 0.73, 95% CI 0.51-1.04) and confirmed methylation of the O6-methylguanine-DNA-methyltransferase (MGMT) gene promoter, lower age at diagnosis, absence of deep brain and multilocular localization, higher Karnofsky Performance Status (KPS) and recurrent therapies to be associated with longer PPS. In contrast, traditional eloquence and duration of progression-free survival had no effect on PPS. Subgroup analyses showed that all subgroups of confirmed predictors benefited from resection, except for patients in poor condition with a KPS <70.

Conclusions: Out data suggest a role for complete and incomplete recurrent resection in progressive GBM patients regardless of methylation of MGMT, age, or adjuvant therapy but not in patients with a poor clinical condition with a KPS <70.

Keywords: extent of resection; post progression survival; progressive glioblastoma; re-surgery; recurrent surgery; resectability; surgery.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Trial profile. Flow diagram of patients with progressive. IDH-Wildtype glioblastoma.
Figure 2
Figure 2
Post-progression survival by extent of resection. Panel (A) shows post-progression survival in Kaplan-Meier estimates for patients stratified by complete, incomplete, and no resection. In panel (B) the group of patients who had no resection was divided into those with either good resectable or bad resectable tumors.
Figure 3
Figure 3
Subgroup analysis of post-progression survival by age, MGMT, KPS, and adjuvant therapy. Post-progression survival is presented in Kaplan-Meier estimates, each bivariately stratified by extent of resection and age (A), MGMT methylation (B), KPS (C), or adjuvant therapy (D).
Figure 4
Figure 4
Post-progression survival in patients with favorable and unfavorable constellation of covariates. Panel (A) shows post-progression survival in Kaplan-Meier estimates for patients with a favorable and panel (B) for an unfavorable constellation of the covariates age, MGMT, KPS, and adjuvant therapy stratified by extent of resection.
See this image and copyright information in PMC

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