On the value of microsurgical resection compared to biopsy in elderly glioblastoma patients: A retrospective...

Benefits of tumor resection in elderly glioblastoma multiforme (GBM) patients within the framework of multimodal treatment remains a matter of debate. This retrospective, multicenter analysis aims at the identification of patients who are most likely to benefit from microsurgical resection, and the development of a scoring system to improve future decision-making.

Demographic and outcome data of GBM patients aged 65 years and older, who underwent resection or biopsy at three centers between 2003 and 2022, were analyzed. Frailty was assessed by the Modified 5-Item Frailty Index (mFI-5).

We studied 537 patients (median age 73.4 years); 369 (68.7%) underwent resection and 168 (31.3%) underwent biopsy. Resected patients were younger, were preoperatively more commonly functionally independent, were less frail, and had larger tumor volumes (all P < .001). The median overall survival was 9.1 [confidence interval (CI) 95% 7.9-10.5] months for resected and 2.8 (CI 95% 2.1-4.3) months for biopsied patients (P < .001). The strongest preoperatively determinable predictors for poor survival were older age, significant frailty (mFI-5 ≥ 2), and deep-seated tumor location for, both, resected and biopsied patients (P < .001). Based on this, a score (0-5 points) incorporating these parameters was developed. Among patients with assumed favorable prognosis (score ≤ 1) the median survival difference between resection and biopsy was 7.5 months, whereas in case of poor prognosis (score ≥ 4) the difference was 2.1 months. No long-term survivors ≥24 months had a score of ≥3 points.

Selected elderly glioblastoma patients might benefit from microsurgical resection. A score to guide neurosurgical treatment decision-making and patient counseling was developed.