TY - JOUR
T1 - Prognostic evaluation of re-resection for recurrent glioblastoma using the novel RANO classification for extent of resection
T2 - A report of the RANO resect group
AU - Karschnia, Philipp
AU - Dono, Antonio
AU - Young, Jacob S.
AU - Juenger, Stephanie T.
AU - Teske, Nico
AU - Häni, Levin
AU - Sciortino, Tommaso
AU - Mau, Christine Y.
AU - Bruno, Francesco
AU - Nunez, Luis
AU - Morshed, Ramin A.
AU - Haddad, Alexander F.
AU - Weller, Michael
AU - van den Bent, Martin
AU - Beck, Juergen
AU - Hervey-Jumper, Shawn
AU - Molinaro, Annette M.
AU - Tandon, Nitin
AU - Rudà, Roberta
AU - Vogelbaum, Michael A.
AU - Bello, Lorenzo
AU - Schnell, Oliver
AU - Grau, Stefan J.
AU - Chang, Susan M.
AU - Berger, Mitchel S.
AU - Esquenazi, Yoshua
AU - Tonn, Joerg Christian
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology.
PY - 2023/9
Y1 - 2023/9
N2 - BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, "maximal resection" (class 2) had superior survival compared to "submaximal resection" (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, "supramaximal resection" of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.
AB - BACKGROUND: The value of re-resection in recurrent glioblastoma remains controversial as a randomized trial that specifies intentional incomplete resection cannot be justified ethically. Here, we aimed to (1) explore the prognostic role of extent of re-resection using the previously proposed Response Assessment in Neuro-Oncology (RANO) classification (based upon residual contrast-enhancing (CE) and non-CE tumor), and to (2) define factors consolidating the surgical effects on outcome. METHODS: The RANO resect group retrospectively compiled an 8-center cohort of patients with first recurrence from previously resected glioblastomas. The associations of re-resection and other clinical factors with outcome were analyzed. Propensity score-matched analyses were constructed to minimize confounding effects when comparing the different RANO classes. RESULTS: We studied 681 patients with first recurrence of Isocitrate Dehydrogenase (IDH) wild-type glioblastomas, including 310 patients who underwent re-resection. Re-resection was associated with prolonged survival even when stratifying for molecular and clinical confounders on multivariate analysis; ≤1 cm3 residual CE tumor was associated with longer survival than non-surgical management. Accordingly, "maximal resection" (class 2) had superior survival compared to "submaximal resection" (class 3). Administration of (radio-)chemotherapy in the absence of postoperative deficits augmented the survival associations of smaller residual CE tumors. Conversely, "supramaximal resection" of non-CE tumor (class 1) was not associated with prolonged survival but was frequently accompanied by postoperative deficits. The prognostic role of residual CE tumor was confirmed in propensity score analyses. CONCLUSIONS: The RANO resect classification serves to stratify patients with re-resection of glioblastoma. Complete resection according to RANO resect classes 1 and 2 is prognostic.
UR - https://www.scopus.com/pages/publications/85169847257
U2 - 10.1093/neuonc/noad074
DO - 10.1093/neuonc/noad074
M3 - Article
C2 - 37253096
AN - SCOPUS:85169847257
SN - 1522-8517
VL - 25
SP - 1672
EP - 1685
JO - Neuro-Oncology
JF - Neuro-Oncology
IS - 9
ER -
