The study analyzed the onco-functional outcomes (OFO) after resection of glioblastomas in the eloquent brain. An international, retrospective, match-control study was carried out in four tertiary neurosurgical institutes, Netherlands (The Hague and Rotterdam), Belgium (Leuven) and the United States (Boston). The inclusion criteria were patients with histopathological diagnosis of glioblastoma in eloquent or near eloquent areas of the brain and unifocal lesion.
A novel OFO classification was developed, combining the extent of resection with functional preservation into four categories: OFO 1 (complete resection without deficits), OFO 2 (incomplete resection without deficits), OFO 3 (complete resection with deficits), and OFO 4 (incomplete resection with deficits). The functional loss of the OFO classification was determined by both KPS deterioration and NIHSS deterioration after 6 weeks of surgery and analyzed separately. The threshold for gross-total resection (GTR) was defined as 1 ml or less residual tumor volume.
A total of 858 patients with primary glioblastoma resections in eloquent areas were enrolled with a median age of 65 years. A propensity-score matching was based on various factors including gender, age and preoperative KPS.
Patients in the OFO 1 class (n = 298 [34.7 %] of 858) had a significantly longer median overall survival (OS) (19.0 months vs. 13.5 months, p <0,0001) and progression-free survival (PFS) (9.5 months vs. 7.0 months, p < 0.0001) than patients in the other OFO subgroups.
While the OFO effects were similar in patients with IDH wildtype and MGMT methylated tumors, a positive effect of OFO 1 or a negative effect of OFO 4 was observed in patients with MGMT unmethylated tumors.
The subgroup aged ≥ 70 years differed evidently from the other subgroups: only OFO 1 significantly improved survival outcomes in these patients, while OFO 2, 3, and 4 had similar outcomes.
The authors identified several preoperative factors associated with an increased likelihood of achieving OFO 1, including NIHSS score (NIHSS 2 and higher: OR 1.61, p = 0.012), preoperative KPS (KPS 80 and lower: OR 0.52, p = 0.007), the use of awake craniotomy (OR 1.93, p = 0.008), intraoperative fluorescence (OR 1.61, p = 0.030), intraoperative ultrasound (OR 1.70, p = 0.006) and preoperative tumor volumes of 10 ml or larger (ORs ranging be- tween 0.09–0.19, p < 0.001). Notably the intraoperative fluorescence was also predictive for OFO 3 (complete resection with deficits).
This study highlights that achieving both gross total resection (GTR) and no functional loss (OFO 1) proved beneficial for all glioblastoma patients with MGMT-methylated tumors located in eloquent areas. Also, they presented us with a novel classification that improves the stratification of each patient postoperatively. These findings contribute to clinical decisions specially to choose the best surgical strategy, in which, awake craniotomy might help in maintaining the performance status of these patients.
Fonte: Gerritsen JKW, Mekary RA, Pisică D, Zwarthoed RH, Kilgallon JL, Nawabi NL, Jessurun CAC, Versyck G, Moussa A, Bouhaddou H, Pruijn KP, Fisher FL, Larivière E, Solie L, Kloet A, Tewarie RN, Schouten JW, Bos EM, Dirven CMF, Jacques van den Bent M, Chang SM, Smith TR, Broekman MLD, Vincent AJPE, De Vleeschouwer PS. Onco-functional outcome after resection for eloquent glioblastoma (OFO): A propensity-score matched analysis of an international, multicentre, cohort study. Eur J Cancer. 2024 Nov;212:114311. doi: 10.1016/j.ejca.2024.114311. Epub 2024 Sep 18. PMID: 39305740.
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