Liu Lingyu, Liao Chihyi, Ge Siqi, Liu Xing, Dong Jiahan, Weng Shimeng, Huang Guoshi, Zhang Zhong, Jin Qiang, Wang Jiangwei, Fan Xing, Zhang Ke-Nan, Jiang Tao
Department of Molecular Neuropathology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Cancer Lett. 2025 Mar 1;612:217471. doi: 10.1016/j.canlet.2025.217471. Epub 2025 Jan 20.
Supramaximal resection in glioblastoma, concerning non-contrast-enhancing (nCE) tumors, exhibited additional survival benefits. However, whether all patients can benefit from supramaximal resection of nCE tumors and the optimal resection target remains unclear, especially for the glioblastoma, IDH-wildtype under the new WHO CNS tumor classification. Clinical and surgical characteristics were collected from 155 patients with newly diagnosed glioblastoma, IDH-wildtype from the Chinese Glioma Genome Atlas, and a prospective cohort of 128 patients was enrolled for external validation. Recursive partitioning analysis was used to identify risk groups considering the effects of residual nCE tumor volume (RnTV) and clinical factors on overall survival (OS). Age, preoperative Karnofsky Performance Score (KPS), MGMT promoter status, and postoperative RnTV were independently associated with patient survival. Four risk groups with distinct prognoses were identified: Group 1 (median OS: 13.4 months), RnTV >43.27 ml; Group 2 (median OS: 17.8 months), RnTV ≤43.27 ml, KPS ≤90, and age ≥60; Group 3 (median OS: 22.3 months), RnTV 5.27-43.27 ml, age <60; Group 4 (median OS: 38.2 months) including 4a, KPS 100 and RnTV ≤43.27 ml; and 4b, KPS ≤90, age <60, and RnTV ≤5.27 ml. These results were retained regardless of MGMT promoter methylation status and validated in the external prospective validation cohort. Supramaximal nCE tumor resection enhances survival outcomes in glioblastoma, IDH-wildtype, but depending on clinical characteristics. In young symptomatic patients, supramaximal resection should be recommended with the RnTV ≤5.27 ml; in symptomless patients or elder patients, keeping the RnTV ≤43.27 is recommended to obtain the survival benefit from tumor resection surgery.
在胶质母细胞瘤中，对于非增强（nCE）肿瘤进行超最大范围切除显示出额外的生存益处。然而，是否所有患者都能从nCE肿瘤的超最大范围切除中获益以及最佳切除靶点仍不明确，尤其是在世界卫生组织（WHO）新的中枢神经系统肿瘤分类下的IDH野生型胶质母细胞瘤。从中国胶质瘤基因组图谱中收集了155例新诊断的IDH野生型胶质母细胞瘤患者的临床和手术特征，并纳入了一个128例患者的前瞻性队列进行外部验证。使用递归划分分析来确定风险组，考虑残留nCE肿瘤体积（RnTV）和临床因素对总生存期（OS）的影响。年龄、术前卡诺夫斯基功能状态评分（KPS）、MGMT启动子状态和术后RnTV与患者生存独立相关。确定了四个预后不同的风险组：第1组（中位OS：13.4个月），RnTV>43.27 ml；第2组（中位OS：17.8个月），RnTV≤43.27 ml，KPS≤90且年龄≥60岁；第3组（中位OS：22.3个月），RnTV 5.27 - 43.27 ml，年龄<60岁；第4组（中位OS：38.2个月）包括4a，KPS 100且RnTV≤43.27 ml；以及4b，KPS≤90，年龄<60岁且RnTV≤5.27 ml。无论MGMT启动子甲基化状态如何，这些结果均成立，并在外部前瞻性验证队列中得到验证。超最大范围切除nCE肿瘤可提高IDH野生型胶质母细胞瘤的生存结局，但取决于临床特征。对于年轻有症状的患者，建议RnTV≤5.27 ml时进行超最大范围切除；对于无症状患者或老年患者，建议将RnTV≤至43.27，以从肿瘤切除手术中获得生存益处。
