Pichardo-Rojas Pavel S, Garcia-Torrico Fabricio, Espinosa-Cantú César B, Rodriguez-Elvir Francisco A, la Fuente Andrea C Beltran-De, Hernandez-Garcia Myriam S, Trippett James S, Morell Alexis, Shah Ashish H, Komotar Ricardo J, Esquenazi Yoshua
The Vivian L. Smith Department of Neurosurgery, The University of Texas Health Science Center at Houston McGovern Medical School, Houston, TX, USA.
Universidad Mayor de San Andrés, La Paz, Bolivia.
J Neurooncol. 2025 May 2. doi: 10.1007/s11060-025-05058-1.
Despite conflicting evidence, reoperation for recurrent glioblastoma (rGBM) achieving complete resection of enhancing-tumor (CRET) may offer benefits over partial resection or salvage therapy alone. However, pooled analyses remain limited.
A systematic search identified rGBM studies comparing reoperation and non-reoperation, including chemotherapy with/without radiotherapy, radiation-based therapies (RBT), and best supportive care (BSC).
Thirty-six studies, comprising 10,738 patients, were included, with 2,806 undergoing reoperation. Nine propensity-score-matched studies and one clinical trial were identified. Mean overall survival (OS) favored reoperation (19.66 months) over chemotherapy with/without radiotherapy (12.56 months, p < 0.00001) and BSC (4.04 months, p < 0.00001), but not over chemotherapy alone (14.60 months) or RBT (14.26 months)(p > 0.05). Multivariate OS favored reoperation over chemotherapy with/without radiation(HR = 0.62,95%CI:0.50-0.76,p < 0.00001), but not to stereotactic radiosurgery (SRS) (HR = 0.52,95%CI:0.25-1.08,p = 0.08) or chemotherapy alone (HR = 0.80,95%CI:0.63-1.00,p = 0.05). Progression-free survival after recurrence (PFS2) was only compared between reoperation and chemotherapy with/without radiotherapy, favoring reoperation (8.36 vs. 4.97 months, p < 0.00001). Multivariate analysis also favored reoperation (HR = 0.56, 95% CI:0.41-0.76,p = 0.0002).The mean post-recurrence survival (PRS) was 12.18 months in the reoperation group, 9.19 months in the chemotherapy with/without radiotherapy, and 9.64 months in SRS. Multivariate PRS favored reoperation over chemotherapy with/without radiotherapy (HR = 0.78, 95%CI: 0.62-0.98,p = 0.04). CRET with < 1 cm residual tumor correlated with improved PRS over incomplete resection (HR: 0.54, 95%CI:0.39-0.73, p = 0.04).
The role of reoperation in rGBM remains uncertain. While it may improve survival in selected cases, limited high-quality data hinder definitive conclusions. Achieving CRET may correlate with improved PRS over partial resection. Further prospective trials are necessary to guide optimal management of rGBM.
尽管证据相互矛盾，但对复发性胶质母细胞瘤（rGBM）进行再次手术以实现增强肿瘤的完全切除（CRET）可能比单纯部分切除或挽救性治疗更有益。然而，汇总分析仍然有限。
系统检索确定了比较再次手术和非再次手术的rGBM研究，包括化疗联合/不联合放疗、基于放疗的治疗（RBT）和最佳支持治疗（BSC）。
纳入了36项研究，共10738例患者，其中2806例接受了再次手术。确定了9项倾向评分匹配研究和1项临床试验。平均总生存期（OS）显示再次手术（19.66个月）优于化疗联合/不联合放疗（12.56个月，p<0.00001）和BSC（4.04个月，p<0.00001），但不优于单纯化疗（14.60个月）或RBT（14.26个月）（p>0.05）。多变量OS显示再次手术优于化疗联合/不联合放疗（HR=0.62，95%CI：0.50-0.76，p<0.00001），但不优于立体定向放射外科（SRS）（HR=0.52，95%CI：0.25-1.08，p=0.08）或单纯化疗（HR=0.80，95%CI：0.63-1.00，p=0.05）。仅比较了再次手术与化疗联合/不联合放疗后的无进展生存期（PFS2），再次手术更具优势（8.36个月对4.97个月，p<0.00001）。多变量分析也支持再次手术（HR=0.56，95%CI：0.41-0.76，p=0.0002）。再次手术组的平均复发后生存期（PRS）为12.18个月，化疗联合/不联合放疗组为9.19个月，SRS组为9.64个月。多变量PRS显示再次手术优于化疗联合/不联合放疗（HR=0.78，95%CI：0.62-0.98，p=0.04）。残留肿瘤<1 cm的CRET与不完全切除相比，PRS改善相关（HR：0.54，95%CI：0.39-0.73，p=0.04）。
再次手术在rGBM中的作用仍不确定。虽然在某些情况下可能改善生存期，但有限的高质量数据阻碍了得出明确结论。与部分切除相比，实现CRET可能与改善PRS相关。需要进一步的前瞻性试验来指导rGBM的最佳管理。
