Counselling Patients With A Glioblastoma Amenable Only for Subtotal Resection: Results Of a multicenter Retrospective Assessment Of Survival and Neurological Outcome.

Counselling Patients With A Glioblastoma Amenable Only for Subtotal Resection: Results Of a multicenter Retrospective Assessment Of Survival and Neurological Outcome.

World Neurosurg. 2018 Apr 02;:

Authors: Coburger J, Segovia J, Ganslandt O, Ringel F, Wirtz CR, Renovanz M

Abstract
INTRODUCTION: Patients with a glioblastoma (GB) amenable only for subtotal resection (STR) represent a challenge in patient counselling. Our objective was to assess impact of extent of resection (EoR) on survival and clinical outcome of these patients.
METHODS: We performed a retrospective multicenter assessment. Patients receiving an intended STR in 3 centers with unilocular, primary, highly eloquent GB who received the same adjuvant treatment were included. We assessed EoR, neurological outcome and rate of complications. Progression free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier-estimations. We used 1%EoR and 1cm³ steps to detect a threshold for a minimal EoR and residual tumor volume (RV) to be beneficial for survival and performed multivariate Cox-regression-models to assess its influence on PFS and OS.
RESULTS: 67 patients were included. EoR and RV were not significantly associated with PFS in multivariate Cox-regression. Multivariate Cox-regression-model for OS revealed that volumetric EoR is a significant predictor for OS (p=0.002, OR 0.982), same as RV (p=0.007, OR 1.03) controlling for age, preoperative tumor volume, sex and recurrent surgery. We found a significant benefit for OS if an EoR>60% or a RV<8cm³ was reached. In the above mentioned multivariate Cox-regression-models an EoR≤60% and a RV≥8cm³ independently showed a significantly negative association with OS (p=0.044,OR1.96/p=0.024,OR2.07).
CONCLUSION: In highly-eloquent GB, EoR significantly matters for patients' OS. Also, potential RV should be considered when treating these patients. In cases with an expected RV above or an EoR below the above-mentioned thresholds, open surgery should be carefully considered.

PMID: 29621607 [PubMed - as supplied by publisher]

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