Onco-functional outcome after resection for eloquent glioblastoma (OFO): A propensity-score matched analysis of an international, multicentre, cohort study.

Autor: Gerritsen JKW; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands. Electronic address: j.gerritsen@erasmusmc.nl., Mekary RA; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Pharmaceutical Business and Administrative Sciences, School of Pharmacy, MCPHS University, Boston, MA, USA., Pisică D; Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands., Zwarthoed RH; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Kilgallon JL; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA., Nawabi NL; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA., Jessurun CAC; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA., Versyck G; Department of Neurosurgery, University Hospital Leuven, Belgium., Moussa A; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands., Bouhaddou H; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Pruijn KP; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Fisher FL; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Larivière E; Department of Neurosurgery, University Hospital Leuven, Belgium., Solie L; Department of Neurosurgery, University Hospital Leuven, Belgium., Kloet A; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Tewarie RN; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands., Schouten JW; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands., Bos EM; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands., Dirven CMF; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands., Jacques van den Bent M; Department of Neuro Oncology, Erasmus Medical Center, Rotterdam, the Netherlands., Chang SM; Department of Neurosurgery, University of California, San Francisco, USA., Smith TR; Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, USA., Broekman MLD; Department of Neurosurgery, Haaglanden Medical Center, The Hague, the Netherlands; Department of Neurosurgery, Leiden University Medical Center, the Netherlands; Department of Cell and Chemical Immunology, Leiden University Medical Center, the Netherlands., Vincent AJPE; Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands., De Vleeschouwer PS; Department of Neurosurgery, University Hospital Leuven, Belgium.
Jazyk: angličtina
Zdroj: European journal of cancer (Oxford, England : 1990) [Eur J Cancer] 2024 Nov; Vol. 212, pp. 114311. Date of Electronic Publication: 2024 Sep 18.
DOI: 10.1016/j.ejca.2024.114311
Abstrakt: Background: The combined impact of complete resection (oncological goal) and no functional loss (functional goal) in glioblastoma subgroups is currently unknown. This study aimed to develop a novel onco-functional outcome (OFO) to merge these two goals into one outcome, resulting in four classes: complete without deficits (OFO1), incomplete without deficits (OFO2), complete with deficits (OFO3), or incomplete with deficits (OFO4).
Methods: Between 2010-2020, 858 patients with tumor resection for eloquent glioblastoma were included. We analyzed the impact of OFO class on postoperative surgical outcomes using Cox proportional-hazards models with hazard ratios (HR) or logistic regression with odds ratios (OR), followed by specific subgroup analyses. We developed a risk model to predict OFO class preoperatively using logistic regression.
Results: The OFO classification stratified the four OFO classes for overall survival (OS:19.0 versus 14.0 versus 12.0 versus 9.0 months), progression-free survival (PFS), and adjuvant therapy. OFO1 was associated with improved OS [HR= 0.67, (0.55-0.81); p < 0.001], and PFS [HR = 0.68, (0.57-0.81); p < 0.001] in the overall cohort and all clinical and molecular subgroups, except for MGMT-unmethylated tumors; and higher rate of adjuvant therapy [OR= 2.81, (1.71-4.84);p < 0.001]. In patients≥ 70 years, only OFO1 improved their survival outcomes. Safe surgery was especially important in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Awake craniotomy more often led to OFO1 compared to asleep resection [OR = 1.93, (1.19-3.14); p = 0.008].
Conclusions: OFO1 was associated with improved OS, PFS, and receipt of adjuvant therapy in all glioblastoma patients with IDH-wildtype and MGMT-methylated tumors. Awake craniotomy was associated with achieving this optimal OFO status. Preventing deficits was more important than complete surgery.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. MvdB has received honoraria for consultancy from Anheart Therapeutics, Boehringer Ingelheim, Fore Biotherapeutics, Genenta, Incyte, Mundipharm, Chimerix, Roche, and Servier. All remaining authors have declared no conflicts of interest.
(Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE