Total Resection for Glioblastoma Predicts Longer Survival

The study covered in this summary was published on researchsquare.com as a preprint and has not yet been peer reviewed.

Key Takeaway

• Gross total resection is an independent predictor of longer survival and good postoperative functional recovery in patients with isocitrate dehydrogenase (IDH)–wildtype glioblastoma, regardless of baseline frailty scores.

Why This Matters

• The management of frail, elderly patients with an IDH-wildtype glioblastoma is controversial, and there is no standardized therapeutic approach.

• The team found that gross total resection is feasible and that complication rates are low, even in frail patients.

• The results build a case for aggressive resection in older, frail patients.

Study Design

• The team reviewed records of 47 patients aged 65 years or older with IDH-wildtype glioblastoma. The researchers correlated surgical outcomes with baseline variables, including scores on the five-item modified frailty index (5-mFI).

• The frailty score was calculated by assigning a point to the following comorbidities: functional dependent status, history of diabetes mellitus, hypertension, chronic obstructive pulmonary disease or pneumonia, and congestive heart failure.

• Surgical approach was left to the neurosurgeon's discretion.

• The mean age of the patients was 73 years; two thirds were men.

Key Results

• A gross total resection was performed in 26 patients (55.3%), a subtotal resection in 13 patients (27.6%), and a biopsy in eight patients (17.1%).

• A baseline 5-mFI score of 1 was most common, occurring in 63.8% of patients. Two patients had a score of 4.

• The rate of 30-day postoperative complications was higher in the biopsy group (37.5%) compared to the subtotal (25.9%) and total (23.1%) resection groups.

• The 30-day postoperative complication rate was also higher among patients with a 5-mFI score of 4 (50%) than among those with a score of 0 (20%) or 1 (30%).

• Gross total resection (adjusted hazard ratio [aHR], 3.51; P = .006) and age ≤70 years (aHR, 4.98, P = .002) were independent predictors of longer overall survival.

• Baseline 5-mFI score was not an independent predictor of overall survival or functional outcomes.

Limitations

• The study was retrospective. It was performed at a single center, and there was no control group.

• The small patient population limits the generalizability of the results.

Disclosures

• The study received no funding. The investigators have disclosed no relevant financial relationships.

This is a summary of a preprint research study, "Surgical Resection Predicts Overall Survival even in Frail Patients With IDH-Wildtype Glioblastomas," led by Angela Elia of the Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. The study has not been peer reviewed. The full text can be found at researchsquare.com.

M. Alexander Otto is a physician assistant with a master’s degree in medical science and a journalism degree from Newhouse. He is an award-winning medical journalist who has worked for several major news outlets before joining Medscape and also an MIT Knight Science Journalism fellow. Email: aotto@mdedge.com.

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