Download PDF
J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 262-268
DOI: 10.1055/s-0039-1685170
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

Yahya Ahmadipour
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Monika Kaur
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Daniela Pierscianek
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Oliver Gembruch
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Marvin Darkwah Oppong
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Oliver Mueller
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Ramazan Jabbarli
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Martin Glas
2   Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
,
Ulrich Sure
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Nicolai El Hindy
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
› Author Affiliations
Further Information

Publication History

05 August 2018

11 January 2019

Publication Date:
09 April 2019 (online)

    Permissions and Reprints

Abstract

Objective Extent of resection (EOR) and Karnofsky Performance Status (KPS) are at odds in glioblastoma (GBM) surgery, that is, the anticipated postoperative disability limits the EOR. This study analyzes the correlation of different surgical modalities with the resulting physical status and survival of patients with GBM.

Methods A total of 565 patients with primary GBM were operated on in a single institution between 2006 and 2014. Possible surgical modalities comprised supratotal resection (SLR), gross total resection (GTR; ≥ 95% by volume), tumor debulking (TDB; ≤ 95% by volume), and stereotactic biopsy (SB). Pre- and postoperative KPS before and up to 4 weeks after surgery as well as overall survival (OS) rate were determined retrospectively. Hazard ratio (HR) and 95% confidence intervals were calculated using a Cox proportional hazards model.

Results Median postoperative KPS was ≥ 70, irrespective of surgical modality. Mean OS was 12.5 months. Multivariate analysis revealed age ≥ 70 years (HR: 1.93), preoperative KPS < 70 (HR: 2.15), and unmethylation in MGMT promoter (HR: 1.27) as independent factors for worse OS. Regarding surgical modality, SB was associated with the worst survival (HR: 2.3) followed by TDB (HR: 1.36). SLR was inferior to GTR (HR: 1.27).

Conclusion Higher EOR in patients with GBM does not seem inevitably correlated with increasing functional impairment, but better survival, provided there is a balanced preoperative indication. Nevertheless, SLR does not seem to be superior to GTR. Whenever possible, maximal safe resection should be considered in patients with GBM, even if an EOR ≥ 95% is not possible.

Keywords

glioblastoma - extent of resection - overall survival - KPS

Ethical Approval

The investigation was approved by the local ethic committees (protocol number 15–6505-BO).


 

  • References

  • 1 Weller M, van den Bent M, Hopkins K. , et al; European Association for Neuro-Oncology (EANO) Task Force on Malignant Glioma. EANO guideline for the diagnosis and treatment of anaplastic gliomas and glioblastoma. Lancet Oncol 2014; 15 (09) e395-e403
    CrossrefPubMedGoogle Scholar
  • 2 Stupp R, Mason WP, van den Bent MJ. , et al; European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005; 352 (10) 987-996
    CrossrefPubMedGoogle Scholar
  • 3 Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol 2004; 6 (03) 227-235
    CrossrefPubMedGoogle Scholar
  • 4 Hegi ME, Diserens AC, Gorlia T. , et al. MGMT gene silencing and benefit from temozolomide in glioblastoma. N Engl J Med 2005; 352 (10) 997-1003
    CrossrefPubMedGoogle Scholar
  • 5 Mineo JF, Bordron A, Baroncini M. , et al. Prognosis factors of survival time in patients with glioblastoma multiforme: a multivariate analysis of 340 patients. Acta Neurochir (Wien) 2007; 149 (03) 245-252 ; discussion 252–253
    CrossrefPubMedGoogle Scholar
  • 6 Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med 2008; 359 (05) 492-507
    CrossrefPubMedGoogle Scholar
  • 7 Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection?. J Neurosurg 2016; 124 (04) 977-988
    CrossrefPubMedGoogle Scholar
  • 8 Stummer W, Reulen HJ, Meinel T. , et al; ALA-Glioma Study Group. Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias. Neurosurgery 2008; 62 (03) 564-576 ; discussion 564–576
    CrossrefPubMedGoogle Scholar
  • 9 Sanai N, Polley MY, McDermott MW, Parsa AT, Berger MS. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg 2011; 115 (01) 3-8
    CrossrefPubMedGoogle Scholar
  • 10 Kreth FW, Thon N, Simon M. , et al; German Glioma Network. Gross total but not incomplete resection of glioblastoma prolongs survival in the era of radiochemotherapy. Ann Oncol 2013; 24 (12) 3117-3123
    CrossrefPubMedGoogle Scholar
  • 11 Stummer W, Pichlmeier U, Meinel T, Wiestler OD, Zanella F, Reulen HJ. ; ALA-Glioma Study Group. Fluorescence-guided surgery with 5-aminolevulinic acid for resection of malignant glioma: a randomised controlled multicentre phase III trial. Lancet Oncol 2006; 7 (05) 392-401
    CrossrefPubMedGoogle Scholar
  • 12 Esquenazi Y, Friedman E, Liu Z, Zhu JJ, Hsu S, Tandon N. The survival advantage of “supratotal” resection of glioblastoma using selective cortical mapping and the subpial technique. Neurosurgery 2017; 81 (02) 275-288
    CrossrefPubMedGoogle Scholar
  • 13 Dammers R, Haitsma IK, Schouten JW, Kros JM, Avezaat CJ, Vincent AJ. Safety and efficacy of frameless and frame-based intracranial biopsy techniques. Acta Neurochir (Wien) 2008; 150 (01) 23-29
    CrossrefPubMedGoogle Scholar
  • 14 Karnofsky DA, Albelman WH, Craver LF. , et al. The use of nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948; 1: 634-656
    CrossrefPubMedGoogle Scholar
  • 15 Altieri R, Zenga F, Fontanella MM. , et al. Glioma surgery: technological advances to achieve a maximal safe resection. Surg Technol Int 2015; 27: 297-302
    PubMedGoogle Scholar
  • 16 Sanai N, Berger MS. Glioma extent of resection and its impact on patient outcome. Neurosurgery 2008; 62 (04) 753-764 ; discussion 264–266
    CrossrefPubMedGoogle Scholar
  • 17 Schaich M, Kestel L, Pfirrmann M. , et al. A MDR1 (ABCB1) gene single nucleotide polymorphism predicts outcome of temozolomide treatment in glioblastoma patients. Ann Oncol 2009; 20 (01) 175-181
    CrossrefPubMedGoogle Scholar
  • 18 Zouaoui S, Darlix A, Fabbro-Peray P. , et al. Oncological patterns of care and outcomes for 265 elderly patients with newly diagnosed glioblastoma in France. Neurosurg Rev 2014; 37 (03) 415-423 ; discussion 423–424
    CrossrefPubMedGoogle Scholar
  • 19 Smith JS, Chang EF, Lamborn KR. , et al. Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas. J Clin Oncol 2008; 26 (08) 1338-1345
    CrossrefPubMedGoogle Scholar
  • 20 Yordanova YN, Moritz-Gasser S, Duffau H. Awake surgery for WHO grade II gliomas within “noneloquent” areas in the left dominant hemisphere: toward a “supratotal” resection. Clinical article. J Neurosurg 2011; 115 (02) 232-239
    CrossrefPubMedGoogle Scholar
  • 21 Sherriff J, Tamangani J, Senthil L. , et al. Patterns of relapse in glioblastoma multiforme following concomitant chemoradiotherapy with temozolomide. Br J Radiol 2013; 86 (1022): 20120414
    CrossrefPubMedGoogle Scholar
  • 22 Demuth T, Berens ME. Molecular mechanisms of glioma cell migration and invasion. J Neurooncol 2004; 70 (02) 217-228
    CrossrefPubMedGoogle Scholar
  • 23 Dandy W. Removal of the right hemisphere for certain tumors with hemiplegia: preliminary report. J Am Med Assoc 1928; 90: 823-825
    CrossrefPubMedGoogle Scholar
  • 24 Bell Jr E, Karnosh LJ. Cerebral hemispherectomy; report of a case 10 years after operation. J Neurosurg 1949; 6 (04) 285-293
    CrossrefPubMedGoogle Scholar
  • 25 Petrecca K, Guiot MC, Panet-Raymond V, Souhami L. Failure pattern following complete resection plus radiotherapy and temozolomide is at the resection margin in patients with glioblastoma. J Neurooncol 2013; 111 (01) 19-23
    CrossrefPubMedGoogle Scholar
  • 26 Trifiletti DM, Alonso C, Grover S, Fadul CE, Sheehan JP, Showalter TN. Prognostic implications of extent of resection in glioblastoma: analysis from a large database. World Neurosurg 2017; 103: 330-340
    CrossrefPubMedGoogle Scholar
  • 27 Brown TJ, Brennan MC, Li M. , et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol 2016; 2 (11) 1460-1469
    CrossrefPubMedGoogle Scholar
  • 28 Chaichana KL, Chaichana KK, Olivi A. , et al. Surgical outcomes for older patients with glioblastoma multiforme: preoperative factors associated with decreased survival. Clinical article. J Neurosurg 2011; 114 (03) 587-594
    CrossrefPubMedGoogle Scholar
  • 29 McGirt MJ, Chaichana KL, Gathinji M. , et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110 (01) 156-162
    CrossrefPubMedGoogle Scholar
  • 30 Duffau H. Is supratotal resection of glioblastoma in noneloquent areas possible?. World Neurosurg 2014; 82 (1–2): e101-e103
    CrossrefPubMedGoogle Scholar