Mut Melike, Zengin Hatice Yagmur, Azizova Aynur, Askun Cengiz Savas, Schiff David, Soylemezoglu Figen
Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA.
Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara 06100, Turkey.
Brain Sci. 2025 Apr 27;15(5):463. doi: 10.3390/brainsci15050463.
This study aims to evaluate the overall survival benefits of repeat resection in patients with recurrent glioblastoma, IDH-wildtype (rGBM), and to identify factors for long-term survival, including the role of clinical, radiological, and molecular parameters.
This longitudinal matched case-control study included 60 patients with rGBM divided into two groups: one surgery ( = 30) and repeat resection ( = 30). The baseline characteristics, preoperative and postoperative volumes, and molecular markers were assessed. Survival analyses were conducted using the Log-rank test, and associated factors with long-term survival were identified in the repeat resection cohort.
The patients who underwent repeat resection had a significantly longer median survival of 23.9 months compared to 9.2 months in the one-surgery group ( < 0.001). Preoperative tumor volume was found to correlate with postoperative residual volume in repeat resections. The patients with no residual contrast-enhancing tumor volume (0 cm) after repeat resection had a median survival of 19.33 months, while those with any residual volume had a median survival of 10.13 months. The patients with lower KPS (≤70) and GCS (≤13) scores at the time of the repeat resection tended to have shorter survival, underscoring the potential clinical relevance of functional status when evaluating surgical candidacy.
Complete repeat resection may improve overall survival in patients with recurrent IDH-wildtype GBM and should be considered earlier as a therapeutic option rather than a diagnostic or salvage procedure. Early surgical intervention, before declines in the KPS and GCS or tumor volumes become unmanageable, may lead to better outcomes. Further studies with larger cohorts are needed to confirm these findings.
本研究旨在评估异柠檬酸脱氢酶野生型复发性胶质母细胞瘤（rGBM）患者再次手术的总生存获益，并确定长期生存的因素，包括临床、影像学和分子参数的作用。
这项纵向匹配病例对照研究纳入了60例rGBM患者，分为两组：一次手术组（n = 30）和再次切除组（n = 30）。评估了基线特征、术前和术后体积以及分子标志物。使用对数秩检验进行生存分析，并在再次切除队列中确定与长期生存相关的因素。
与一次手术组的9.2个月相比，接受再次切除的患者中位生存期显著更长，为23.9个月（P < 0.001）。发现术前肿瘤体积与再次切除术后的残余体积相关。再次切除后无残余强化肿瘤体积（0 cm）的患者中位生存期为19.33个月，而有任何残余体积的患者中位生存期为10.13个月。再次切除时KPS（≤70）和GCS（≤13）评分较低的患者生存期往往较短，这突出了评估手术候选资格时功能状态的潜在临床相关性。
完全再次切除可能改善异柠檬酸脱氢酶野生型复发性GBM患者的总生存，应更早地将其视为一种治疗选择，而非诊断或挽救性手术。在KPS和GCS下降或肿瘤体积变得难以控制之前进行早期手术干预，可能会带来更好的结果。需要更大样本量的进一步研究来证实这些发现。
