Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group

Philipp Karschnia, Jacob S. Young, Antonio Dono, Levin Haeni, Tommaso Sciortino, Francesco Bruno, Stephanie T. Juenger, Nico Teske, Ramin A. Morshed, Alexander F. Haddad, Yalan Zhang, Sophia Stoecklein, Michael Weller, Michael A. Vogelbaum, Juergen Beck, Nitin Tandon, Shawn Hervey-Jumper, Annette M. Molinaro, Roberta Ruda, Lorenzo BelloOliver Schnell, Yoshua Esquenazi, Maximilian Ruge, Stefan J. Grau, Mitchel S. Berger, Susan M. Chang, Martin van den Bent, Joerg-Christian Tonn*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

52 Citations (Scopus)
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Background Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit. Methods The international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and postoperative MRI were collected. Results We collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT -> TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm(3)) were favorably associated with outcome: patients with "maximal CE resection" (class 2) had superior outcome compared to patients with "submaximal CE resection" (class 3) or "biopsy" (class 4). Extensive resection of non-CE tumor (<= 5 cm(3) residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ("supramaximal CE resection"). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers. Conclusions The proposed "RANO categories for extent of resection in glioblastoma" are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such "supramaximal CE resection."
Original languageEnglish
Pages (from-to)940-954
Number of pages15
Issue number5
Early online date12 Aug 2022
Publication statusPublished - 1 May 2023

Bibliographical note

Publisher Copyright:
© 2022 The Author(s). Published by Oxford University Press on behalf of the Society for Neuro-Oncology.


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