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Impact of extent of surgical resection on survival in World Health Organization grade 4 gliomas: A molecular
Ziming Hou1,2, Wenhao Zhang3, Zeya Yan4
1Department of Neurosurgery, Beijing Luhe Hospital, Capital Medical University, Beijing, China (Z.H., H.W.).
Background:
Extensive surgical resection is associated with longer survival in patients with glioma; however, the combined impact of surgical extent and molecular pathology on prognosis remains unclear. In this study, we evaluated how molecular pathology and clinical features influence surgical outcomes in patients with World Health Organization (WHO) grade 4 gliomas, including isocitrate dehydrogenase (IDH)-mutant astrocytomas and IDH wild-type glioblastomas.
Methods:
Data from 501 patients with WHO grade 4 gliomas who underwent surgery were obtained from the Chinese Glioma Genome Atlas database (2005-2019). The effect of resection extent on overall survival was analyzed and stratified using molecular pathology and clinical characteristics. Survival differences were assessed using the Kaplan-Meier method and the log-rank test, and prognostic factors were identified through univariate and multivariate analyses.
Results:
The extent of resection significantly influenced survival, but its impact varied by molecular subtype. In WHO grade 4 IDH-mutant astrocytomas, gross total resection (GTR) did not confer a significant survival advantage over subtotal resection (STR). Among glioblastoma patients, those with non-methylated O-(6)-methylguanine-DNA methyltransferase promoters and preoperative Karnofsky Performance Status ≤80 showed no significant benefit from GTR compared to STR, whereas GTR substantially prolonged survival in other subgroups.
Conclusions:
The survival benefits of extensive resection vary among patients with WHO grade 4 glioma. Molecular pathology and clinical characteristics should be considered in surgical planning. A conservative approach may be appropriate for some patients; nevertheless, a more aggressive strategy may optimize survival and quality of life for others.
Insights
Surgical extent impacts glioma survival, but benefits differ by molecular subtype and clinical factors. Personalized surgical planning is crucial for optimizing outcomes in World Health Organization grade 4 gliomas.
Area of Science:
- Neuro-oncology
- Surgical oncology
- Molecular pathology
Background:
- Surgical resection extent correlates with survival in glioma patients.
- The combined influence of surgical extent and molecular pathology on prognosis is not fully understood.
- This study investigates molecular and clinical factors affecting surgical outcomes in World Health Organization (WHO) grade 4 gliomas.
Purpose of the Study:
- To evaluate how molecular pathology and clinical features influence surgical outcomes in patients with WHO grade 4 gliomas.
- To determine the differential impact of surgical resection extent on survival based on glioma molecular subtypes.
- To inform surgical planning for WHO grade 4 gliomas by considering individual patient characteristics.
Main Methods:
- Analysis of data from 501 patients with WHO grade 4 gliomas who underwent surgery (Chinese Glioma Genome Atlas database, 2005-2019).
- Stratification of resection extent's effect on overall survival by molecular pathology and clinical characteristics.
- Kaplan-Meier method, log-rank test, and univariate/multivariate analyses to assess survival differences and identify prognostic factors.
Main Results:
- Resection extent significantly affected survival, with variations across molecular subtypes.
- Gross total resection (GTR) did not significantly improve survival over subtotal resection (STR) in IDH-mutant astrocytomas.
- In glioblastoma, GTR offered survival benefits for most patients, except those with non-methylated MGMT promoters and Karnofsky Performance Status ≤80.
Conclusions:
- Survival benefits of extensive resection in WHO grade 4 glioma are patient-specific.
- Molecular pathology and clinical features are critical for personalized surgical planning.
- A tailored surgical approach, balancing conservative and aggressive strategies, can optimize survival and quality of life.
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