Gallotti Alberto L, Rossi Marco, Conti Nibali Marco, Sciortino Tommaso, Gay Lorenzo G, Puglisi Guglielmo, Leonetti Antonella, Bruno Francesco, Rudà Roberta, Soffietti Riccardo, Cerri Gabriella, Bello Lorenzo
Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.
Neurosurgery Unit, IRCCS Ospedale Galeazzi Sant'Ambrogio, Milano, Italy.
Neuro Oncol. 2025 Jun 21;27(5):1270-1284. doi: 10.1093/neuonc/noae264.
Supratotal-resection (SpTR) is a promising surgical strategy in lower-grade gliomas (LGGs). SpTR assessment, feasibility and distinctive features, as well as clinical benefit at first and second surgery and on overall survival must be better characterized. The critical percentage of resection exceeding FLAIR margins to obtain clinical benefit and its impact on long-term functional performance are also undefined.
Included were 704 patients with primary and 439 with recurrent LGGs seen between 2010 and 2019, who underwent resection with brain-mapping technique (BMT) aimed at achieving a SpTR without any "a-priori" selection. Extent-of-resection, evaluated on 3D-FLAIR-MR and categorized according to residual tumor and cavity volume, was associated with progression-free survival (PFS) and malignant(M)PFS at first and second surgery and overall survival by univariate, multivariate, and propensity-score analysis. Functional performance was assessed by neuropsychological (NPS) evaluation.
SpTR evaluation requires volumetric assessment enhanced by brain deformation measurement in parietal tumors; SpTR rate accounts on average for 50.2% and 35.7% at first and second surgery is higher in grade-2, frontal, and temporal locations (at expenses of total resection [TR]). Compared to TR, SpTR reduces and postpones first and second recurrences in all molecular subtypes and grades, delays MPFS without difference in rate, and prolongs overall survival (OS). A degree of SpTR > 120% associates with the lowest recurrence risk. SpTR associates with the best NPS longitudinal course.
This study supports the feasibility of SpTR in LGGs, its benefit at first and second surgery regardless of molecular subtypes, and on OS, significantly reducing recurrence when SpTR > 120%; SpTR also associates with the best patients' functional outcome.
次全切除（SpTR）是低级别胶质瘤（LGGs）一种有前景的手术策略。SpTR评估、可行性和独特特征，以及首次和二次手术时的临床获益及对总生存期的影响，都必须得到更好的描述。切除超过液体衰减反转恢复（FLAIR）边界以获得临床获益的关键百分比及其对长期功能表现的影响也尚不明确。
纳入2010年至2019年间就诊的704例原发性和439例复发性LGGs患者，他们接受了旨在实现SpTR的脑图谱技术（BMT）切除，且未进行任何“先验”选择。在三维FLAIR磁共振成像（3D-FLAIR-MR）上评估切除范围，并根据残余肿瘤和腔隙体积进行分类，通过单因素、多因素和倾向评分分析，将其与首次和二次手术时的无进展生存期（PFS）、恶性（M）PFS以及总生存期相关联。通过神经心理学（NPS）评估来评估功能表现。
SpTR评估需要通过测量顶叶肿瘤的脑变形来增强体积评估；首次和二次手术时SpTR率平均分别为50.2%和35.7%，在2级、额叶和颞叶部位更高（以牺牲全切除[TR]为代价）。与TR相比，SpTR在所有分子亚型和级别中均减少并推迟了首次和二次复发，延迟了MPFS但速率无差异，并延长了总生存期（OS）。SpTR程度>120%与最低复发风险相关。SpTR与最佳的NPS纵向病程相关。
本研究支持SpTR在LGGs中的可行性，其在首次和二次手术时无论分子亚型如何均有获益，且对OS有显著益处，当SpTR>120%时可显著降低复发率；SpTR还与最佳的患者功能结局相关。
