Bertolini Giacomo, Trombini Tommaso, Zenesini Corrado, Mazza Stefania, Dascola Isabella, Pavarani Antonio, Michiara Maria, Ceccon Giovanni, Peluso Andrea, Calamo Specchia Francesco Maria, Crafa Pellegrino, Menozzi Roberto, Giombelli Ermanno
Head and Neck Department, Neurosurgery Unit Azienda Ospedaliero-Universitaria di Parma, Viale Antonio Gramsci 14, Parma, 43126, Italy.
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
J Neurooncol. 2025 May 27. doi: 10.1007/s11060-025-05096-9.
The optimal treatment for recurrent glioblastoma (rGBM) remains controversial. We explore the impact of re-surgical resection, compared to solely oncological treatment, in a cohort of isocitrate dehydrogenase (IDH) wild-type rGBM.
A retrospective cohort study included adult patients diagnosed with IDHwt rGBM. At recurrence, patients recieved re-surgical resection (re-surgery group - RSG) or further oncological treatments (chemo-radiation group - CRG). Overall survival (OS) and progression-free survival (PFS) were analyzed. A Cox regression model was performed to identify variables related to outcomes. Furthermore, to minimize possible study design-related bias, a propensity score analysis was applied. Additionally, subgroup analysis to explore the role of adjuvant therapies was performed.
In a cohort of 104 patients with rGBM, 44 patients received re-surgical resection. Patients in RSG experienced a longer OS compared to CRG (21 vs. 12 months, p < 0.001); a shorter survival in the CRG was confirmed at the propensity score analysis (HR 2.16, p = 0.004). The median cohort PFS was 4 months. The PFS was similar between the RSG and CRG (6 vs. 4 months). The variables associated with OS were: age, subventricular zone involvement, repeated chemotherapy. The variables associated with PFS were: extent of resection at first surgery, MGMT methylation, no adjuvant therapies, and delayed radiotherapy. At the subgroup analysis, re-irradiation was not associated with OS or PFS benefit in the RSG; adjuvant chemo-radiation therapy offers a survival advantage compared to standard adjuvant chemotherapy in the CRG.
Re-surgical resection offers a significant survival benefit compared to the sole adjuvant treatment in patients with IDHwt rGBM.
复发性胶质母细胞瘤（rGBM）的最佳治疗方案仍存在争议。我们在一组异柠檬酸脱氢酶（IDH）野生型rGBM患者中，探讨了再次手术切除与单纯肿瘤治疗相比的影响。
一项回顾性队列研究纳入了诊断为IDH野生型rGBM的成年患者。复发时，患者接受再次手术切除（再次手术组 - RSG）或进一步的肿瘤治疗（放化疗组 - CRG）。分析总生存期（OS）和无进展生存期（PFS）。进行Cox回归模型以确定与预后相关的变量。此外，为尽量减少可能与研究设计相关的偏差，应用了倾向评分分析。另外，进行亚组分析以探讨辅助治疗的作用。
在104例rGBM患者队列中，44例患者接受了再次手术切除。RSG组患者的OS比CRG组长（21个月对12个月，p < 0.001）；倾向评分分析证实CRG组生存期较短（HR 2.16，p = 0.004）。队列的中位PFS为4个月。RSG组和CRG组的PFS相似（6个月对4个月）。与OS相关的变量有：年龄、脑室下区受累、重复化疗。与PFS相关的变量有：首次手术切除范围、MGMT甲基化、无辅助治疗和延迟放疗。在亚组分析中，再次放疗与RSG组的OS或PFS获益无关；在CRG组中，辅助放化疗与标准辅助化疗相比具有生存优势。
与IDH野生型rGBM患者的单纯辅助治疗相比，再次手术切除可带来显著的生存获益。
