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Quantitative Immunohistochemistry of the Cellular Microenvironment in Patient Glioblastoma Resections
Published on: July 31, 2017
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Supratotal Resection of Glioblastoma: Is Less More?
Roberto Altieri1, Antonio Melcarne1, Riccardo Soffietti2
1Neurosurgical Unit, Department of Neuroscience, University of Turin, Turin, Italy.
Surgical Technology International
|August 3, 2019
Summary
Extent of resection (EOR) of FLAIR-hyperintense regions does not impact glioblastoma (GBM) survival. However, achieving a high EOR of the enhancing nodule (EN) and minimizing postoperative EN volume are crucial for better prognosis in GBM patients.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
- Glioblastoma Multiforme (GBM) Research
Background:
- Extent of resection (EOR) is linked to survival in glioblastoma (GBM) patients.
- GBMs often recur near the surgical cavity despite gross total resection (GTR) of the enhancing nodule (EN).
Purpose of the Study:
- To evaluate the prognostic significance of FLAIR (Fluid-Attenuated Inversion Recovery) resection in GBM.
- To analyze pre- and post-operative Magnetic Resonance Imaging (MRI) data to estimate EOR for EN, FLAIR-hyperintense regions, and total tumor volume (TTV).
Main Methods:
- Retrospective analysis of radiologic and clinical outcomes.
- Calculation of EOR for EN, FLAIR volumes, and TTV using pre- and post-operative MRI.
- Statistical analysis including time-dependent ROC curves, Kaplan-Meier, log-rank, and Cox regression for progression-free survival (PFS) and overall survival (OS).
Main Results:
- No correlation found between EOR of FLAIR-altered regions and patient survival.
- Preoperative EN volume < 31.35 cm³ and postoperative EN volume < 0.57 cm³ were significantly associated with better prognosis.
- EOR of EN > 96% showed a significant association with improved OS (p=0.0051) and PFS (p=0.022).
Conclusions:
- The extent of resection of FLAIR-hyperintense areas does not influence survival in GBM patients.
- Surgical goals for GBM should focus on maximizing the resection of the enhancing nodule (EN) to improve patient outcomes.
