TY - JOUR
T1 - Onco-functional outcome after resection for eloquent glioblastoma (OFO)
T2 - A propensity-score matched analysis of an international, multicentre, cohort study
AU - Gerritsen, Jasper Kees Wim
AU - Mekary, Rania Angelia
AU - Pisică, Dana
AU - Zwarthoed, Rosa Hanne
AU - Kilgallon, John Laws
AU - Nawabi, Noah Lee
AU - Jessurun, Charissa Alissa Cassandra
AU - Versyck, Georges
AU - Moussa, Ahmed
AU - Bouhaddou, Hicham
AU - Pruijn, Koen Pepijn
AU - Fisher, Fleur Louise
AU - Larivière, Emma
AU - Solie, Lien
AU - Kloet, Alfred
AU - Tewarie, Rishi Nandoe
AU - Schouten, Joost Willem
AU - Bos, Eelke Marijn
AU - Dirven, Clemens Maria Franciscus
AU - Jacques van den Bent, Martin
AU - Chang, Susan Marina
AU - Smith, Timothy Richard
AU - Broekman, Marike Lianne Daphne
AU - Vincent, Arnaud Jean Pierre Edouard
AU - De Vleeschouwer, Prof Steven
N1 - Publisher Copyright: © 2024 The Authors
PY - 2024/11
Y1 - 2024/11
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85204396789&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2024.114311
DO - 10.1016/j.ejca.2024.114311
M3 - Article
C2 - 39305740
AN - SCOPUS:85204396789
SN - 0959-8049
VL - 212
JO - European Journal of Cancer
JF - European Journal of Cancer
M1 - 114311
ER -
