The Impact of Extent of Resection on the Prognosis of Glioblastoma Multiforme: A Systematic Review and Meta-analysis

Dipak Chaulagain; Volodymyr Smolanka; Andriy Smolanka; Sunil Munakomi

doi:10.3889/oamjms.2022.8970

Authors

Dipak Chaulagain Department of Neurosurgery, Uzhhorod National University, Uzhhorod Regional Clinical Center of Neurosurgery and Neurology, Uzhhorod, Ukraine
Volodymyr Smolanka Department of Neurosurgery, Uzhhorod National University, Uzhhorod Regional Clinical Center of Neurosurgery and Neurology, Uzhhorod, Ukraine
Andriy Smolanka Department of Neurosurgery, Uzhhorod National University, Uzhhorod Regional Clinical Center of Neurosurgery and Neurology, Uzhhorod, Ukraine
Sunil Munakomi Department of Neurosurgery, College of Medical Science, Teaching Hospital, Bharatpur, Nepal

DOI:

https://doi.org/10.3889/oamjms.2022.8970

Keywords:

Predictor factors, Glioblastoma multiforme, Extent of resection

Abstract

Purpose:

To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of Glioblastoma Multiforme (GBM).

Materials and Methods:

A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 12^thSeptember 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the Hazards Ratio (HR) and corresponding 95% Confidence interval (CI).

Result:

Twenty-three cohort studies were selected for meta-analysis. There was statistically significant effect of extent of resection on prognosis of surgery in GBM patients (HR= 0.90 [0.86, 0.95]; p< 0.0001; I²= 96%), male gender (HR= 1.19 [1.06, 1.34]; p= 0.002; I²= 0%) and decrease Karnofsky Performance Status (HR= 0.97 [0.95, 0.99]; p= 0.003; I²= 90%). Age and tumor volume was also analyzed in the study.

Conclusion:

The results of our meta-analysis suggested that age, gender, pre-operative KPS score and extent of resection have significant effects on the post-surgical mortality rate, therefore, these factors can be used significant predictor of mortality in GBM patients.

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References

Ahmed R, Oborski MJ, Hwang M, Lieberman FS, Mountz JM. Malignant gliomas: Current perspectives in diagnosis, treatment, and early response assessment using advanced quantitative imaging methods. Cancer Manag Res 2014;6:149-70. https://doi.org/10.2147/cmar.s54726 PMid:24711712 DOI: https://doi.org/10.2147/CMAR.S54726

Ostrom QT, Barnholtz-Sloan JS. Current state of our knowledge on brain tumor epidemiology. Curr Neurol Neurosci Rep. 2011;11(3):329-35. https://doi.org/10.1007/s11910-011-0189-8 PMid:21336822 DOI: https://doi.org/10.1007/s11910-011-0189-8

Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol. 2014;16(4):v1-63. https://doi.org/10.1093/neuonc/nou223 PMid:25304271 DOI: https://doi.org/10.1093/neuonc/nou223

Fisher JL, Schwartzbaum JA, Wrensch M, Wiemels JL. Epidemiology of brain tumors. Neurol Clin. 2007;25(4):867. https://doi.org/10.1016/j.ncl.2007.07.002 PMid:17964019 DOI: https://doi.org/10.1016/j.ncl.2007.07.002

Ohgaki H, Kleihues P. Population-based studies on incidence, survival rates, and genetic alterations in astrocytic and oligodendroglial gliomas. J Neuropathol Exp Neurol. 2005;64(6):479-89. https://doi.org/10.1093/jnen/64.6.479 PMid:15977639 DOI: https://doi.org/10.1093/jnen/64.6.479

Ohgaki H, Kleihues P. Genetic pathways to primary and secondary glioblastoma. Am J Pathol. 2007;170(5):1445-53. https://doi.org/10.2353/ajpath.2007.070011 PMid:17456751 DOI: https://doi.org/10.2353/ajpath.2007.070011

Delgado-López PD, Corrales-García EM. Survival in glioblastoma: A review on the impact of treatment modalities. Clin Transl Oncol. 2016;18(11):1062-71. https://doi.org/10.1007/s12094-016-1497-x DOI: https://doi.org/10.1007/s12094-016-1497-x

Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, et al. European Organisation for Research and Treatment of Cancer Brain Tumor and Radiotherapy Groups, National Cancer Institute of Canada Clinical Trials Group. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352(10):987-96. https://doi.org/10.1056/nejmoa043330 PMid:26960561 DOI: https://doi.org/10.1056/NEJMoa043330

Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: Recursive partitioning analysis. Neuro Oncol. 2004;6(3):227-35. https://doi.org/10.1215/s1152851703000620 PMid:15279715 DOI: https://doi.org/10.1215/S1152851703000620

Lacroix M, Abi-Said D, Fourney DR, Gokaslan ZL, Shi W, DeMonte F, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: Prognosis, extent of resection, and survival. J Neurosurg. 2001;95(2):190-8. https://doi.org/10.3171/jns.2001.95.2.0190 PMid:11780887 DOI: https://doi.org/10.3171/jns.2001.95.2.0190

Brown TJ, Brennan MC, Li M, Church EW, Brandmeir NJ, Rakszawski KL, et al. Association of the extent of resection with survival in glioblastoma: A systematic review and meta-analysis. JAMA Oncol. 2016;2(11):1460-9. https://doi.org/10.1001/jamaoncol.2016.1373 PMid:27310651 DOI: https://doi.org/10.1001/jamaoncol.2016.1373

Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: Checklist and explanations. Ann Intern Med. 2015;162(11):777-84. https://doi.org/10.7326/m14-2385 PMid:26030634 DOI: https://doi.org/10.7326/M14-2385

Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60. PMid:12958120 DOI: https://doi.org/10.1136/bmj.327.7414.557

Boaro A, Kavouridis VK, Siddi F, Mezzalira E, Harary M, Iorgulescu JB, et al. Improved outcomes associated with maximal extent of resection for butterfly glioblastoma: Insights from institutional and national data. Acta Neurochirur. 2021;163(7):1883-94. https://doi.org/10.1007/s00701-021-04844-w PMid:33871698 DOI: https://doi.org/10.1007/s00701-021-04844-w

Keles GE, Chang EF, Lamborn KR, Tihan T, Chang CJ, Chang SM, et al. Volumetric extent of resection and residual contrast enhancement on initial surgery as predictors of outcome in adult patients with hemispheric anaplastic astrocytoma. J Neurosurg. 2006;105(1):34-40. https://doi.org/10.3171/jns.2006.105.1.34 PMid:16871879 DOI: https://doi.org/10.3171/jns.2006.105.1.34

Bloch O, Han SJ, Cha S, Sun MZ, Aghi MK, McDermott MW, et al. Impact of extent of resection for recurrent glioblastoma on overall survival: Clinical article. J Neurosurg. 2012;117(6):1032-8. https://doi.org/10.3171/2012.9.jns12504 PMid:23039151 DOI: https://doi.org/10.3171/2012.9.JNS12504

Chaichana KL, Jusue-Torres I, Lemos AM, Gokaslan A, Cabrera-Aldana EE, Ashary A, et al. The butterfly effect on glioblastoma: Is volumetric extent of resection more effective than biopsy for these tumors? J Neurooncol 2014;120(3):625-34. https://doi.org/10.1007/s11060-014-1597-9 PMid:25193022 DOI: https://doi.org/10.1007/s11060-014-1597-9

Goldman DA, Hovinga K, Reiner AS, Esquenazi Y, Tabar V, Panageas KS. The relationship between repeat resection and overall survival in patients with glioblastoma: A time-dependent analysis. J Neurosurg. 2018;129(5):1231-9. https://doi.org/10.3171/2017.6.jns17393 PMid:29303449 DOI: https://doi.org/10.3171/2017.6.JNS17393

Hauser A, Dutta SW, Showalter TN, Sheehan JP, Grover S, Trifiletti DM. Impact of academic facility type and volume on post-surgical outcomes following diagnosis of glioblastoma. J Clin Neurosci. 2018;47:103-10. https://doi.org/10.1016/j.jocn.2017.10.087 PMid:29113851 DOI: https://doi.org/10.1016/j.jocn.2017.10.087

Huang R, Li G, Li Y, Wang Y, Yang P, Zhang C, et al. Long-term efficacy of surgical resection with or without adjuvant therapy for treatment of secondary glioblastoma in adults. Neurooncol Adv. 2020;2(1):vdaa098. https://doi.org/10.1093/noajnl/vdaa098 PMid:33005897 DOI: https://doi.org/10.1093/noajnl/vdaa098

Ius T, Isola M, Budai R, Pauletto G, Tomasino B, Fadiga L, et al. Low-grade glioma surgery in eloquent areas: Volumetric analysis of extent of resection and its impact on overall survival. A single-institution experience in 190 patients: Clinical article. J Neurosurg. 2012;117(6):1039-52. https://doi.org/10.3171/2012.8.jns12393 PMid:23039150 DOI: https://doi.org/10.3171/2012.8.JNS12393

Kuhnt D, Becker A, Ganslandt O, Bauer M, Buchfelder M, Nimsky C. Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol. 2011;13(12):1339-48. https://doi.org/10.1093/neuonc/nor133 PMid:21914639 DOI: https://doi.org/10.1093/neuonc/nor133

Oppenlander ME, Wolf AB, Snyder LA, Bina R, Wilson JR, Coons SW, et al. An extent of resection threshold for recurrent glioblastoma and its risk for neurological morbidity. J Neurosurg. 2014;120(4):846-53. https://doi.org/10.3171/2013.12.jns13184 PMid:24484232 DOI: https://doi.org/10.3171/2013.12.JNS13184

Song KS, Phi JH, Cho BK, Wang KC, Lee JY, Kim DG, et al. Longterm outcomes in children with glioblastoma. J Neurosurg Pediatr. 2010;6(2):145-9. https://doi.org/10.3171/2010.5.peds09558 PMid:20672935 DOI: https://doi.org/10.3171/2010.5.PEDS09558

Woo P, Ho J, Tse T, Lam SW, Mak C, Chan D, et al. Determining a cut-off residual tumor volume threshold for patients with newly diagnosed glioblastoma treated with temozolomide chemoradiotherapy: A multicenter cohort study. J Clin Neurosci. 2019;63:134-41. https://doi.org/10.1016/j.jocn.2019.01.022 PMid:30712777 DOI: https://doi.org/10.1016/j.jocn.2019.01.022

Bagley SJ, Schwab RD, Nelson E, Viaene AN, Binder ZA, Lustig RA, et al. Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma. J Neurooncol 2019;141(2):421-9. https://doi.org/10.1007/s11060-018-03050-6 DOI: https://doi.org/10.1007/s11060-018-03050-6

Haj A, Doenitz C, Schebesch KM, Ehrensberger D, Hau P, Putnik K, et al. Extent of resection in newly diagnosed glioblastoma: Impact of a specialized neuro-oncology care center. Brain Sci. 2017;8(1):E5. https://doi.org/10.3390/brainsci8010005 PMid:29295569 DOI: https://doi.org/10.3390/brainsci8010005

Kim N, Chang JS, Wee CW, Kim IA, Chang JH, Lee HS, et al. Validation and optimization of a web-based nomogram for predicting survival of patients with newly diagnosed glioblastoma. Strahlenther Onkol. 2020;196(1):58-69. https://doi.org/10.1007/s00066-019-01512-y PMid:31489457 DOI: https://doi.org/10.1007/s00066-019-01512-y

McGirt MJ, Chaichana KL, Gathinji M, Attenello FJ, Than K, Olivi A, et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg. 2009;110(1):156-62. https://doi.org/10.3171/2008.4.17536 PMid:18847342 DOI: https://doi.org/10.3171/2008.4.17536

Opoku-Darko M, Amuah JE, Kelly J. Surgical resection of anterior and posterior butterfly glioblastoma. World Neurosurg. 2018;110:e612-20. https://doi.org/10.1016/j.wneu.2017.11.059 PMid:29162526 DOI: https://doi.org/10.1016/j.wneu.2017.11.059

Louvel G, Metellus P, Noel G, Peeters S, Guyotat J, Duntze J, et al. Delaying standard combined chemoradiotherapy after surgical resection does not impact survival in newly diagnosed glioblastoma patients. Radiother Oncol. 2016;118(1):9-15. https://doi.org/10.1016/j.radonc.2016.01.001 PMid:26791930 DOI: https://doi.org/10.1016/j.radonc.2016.01.001

Sacko O, Benouaich-Amiel A, Brandicourt P, Niaré M, Charni S, Cavandoli C, et al. The impact of surgery on the survival of patients with recurrent glioblastoma. Asian J Neurosurg. 2021;16(1):1-7. https://doi.org/10.4103/ajns.ajns_180_20 PMid:34211860 DOI: https://doi.org/10.4103/ajns.AJNS_180_20

Buszek SM, Al Feghali KA, Elhalawani H, Chevli N, Allen PK, Chung C. Optimal timing of radiotherapy following gross total or subtotal resection of glioblastoma: A real-world assessment using the national cancer database. Sci Rep. 2020;10(1):4926. https://doi.org/10.1038/s41598-020-61701-z PMid:32188907 DOI: https://doi.org/10.1038/s41598-020-61701-z

Hong JB, Roh TH, Kang SG, Kim SH, Moon JH, Kim EH, et al. Survival, prognostic factors, and volumetric analysis of extent of resection for anaplastic gliomas. Cancer Res Treat. 2020;52(4):1041-9. https://doi.org/10.4143/crt.2020.057 PMid:32324987 DOI: https://doi.org/10.4143/crt.2020.057

Li YM, Suki D, Hess K, Sawaya R. The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection? J Neurosurg. 2016;124(4):977-88. https://doi.org/10.3171/2015.5.jns142087 PMid:26495941 DOI: https://doi.org/10.3171/2015.5.JNS142087

Aldave G, Tejada S, Pay E, Marigil M, Bejarano B, Idoate MA, et al. Prognostic value of residual fluorescent tissue in glioblastoma patients after gross total resection in 5-aminolevulinic Acidguided surgery. Neurosurgery. 2013;72(6):915-21. https://doi.org/10.1227/neu.0b013e31828c3974 PMid:23685503 DOI: https://doi.org/10.1227/NEU.0b013e31828c3974

Chambless LB, Kistka HM, Parker SL, Hassam-Malani L, McGirt MJ, Thompson RC. The relative value of postoperative versus preoperative Karnofsky performance scale scores as a predictor of survival after surgical resection of glioblastoma multiforme. J Neurooncol 2015;121(2):359-64. https://doi.org/10.1007/s11060-014-1640-x PMid:25344883 DOI: https://doi.org/10.1007/s11060-014-1640-x

Revilla-Pacheco F, Rodríguez-Salgado P, Barrera-Ramírez M, Morales-Ruiz MP, Loyo-Varela M, Rubalcava-Ortega J, et al. Extent of resection and survival in patients with glioblastoma multiforme: Systematic review and meta-analysis. Medicine (Baltimore). 2021;100(25):e26432. https://doi.org/10.1097/md.0000000000026432 PMid:34160432 DOI: https://doi.org/10.1097/MD.0000000000026432

Li XZ, Li YB, Cao Y, Li PL, Liang B, Sun JD, etal. Prognostic implications of resection extent for patients with glioblastoma multiforme: A meta-analysis. J Neurosurg Sci. 2017;61(6):631-9. https://doi.org/10.23736/s0390-5616.16.03619-5 PMid:26824196 DOI: https://doi.org/10.23736/S0390-5616.16.03619-5

Thumma SR, Fairbanks RK, Lamoreaux WT, Mackay AR, Demakas JJ, Cooke BS, et al. Effect of pretreatment clinical factors on overall survival in glioblastoma multiforme: A surveillance epidemiology and end results (SEER) population analysis. World J Surg Oncol 2012;10:75. https://doi.org/10.1186/1477-7819-10-75 PMid:22553975 DOI: https://doi.org/10.1186/1477-7819-10-75

Brodbelt A, Greenberg D, Winters T, Williams M, Vernon S, Collins VP, National Cancer Information Network Brain Tumour Group. Glioblastoma in England: 2007-2011. Eur J Cancer. 2015;51(4):533-42. https://doi.org/10.1016/j.ejca.2014.12.014 PMid:25661102 DOI: https://doi.org/10.1016/j.ejca.2014.12.014

Brehmer S, Grimm MA, Förster A, Seiz-Rosenhagen M, Welzel G, Stieler F, et al. Study protocol: Early stereotactic gamma knife radiosurgery to residual tumor after surgery of newly diagnosed glioblastoma (Gamma-GBM). Neurosurgery. 2019;84(5):1133-7. https://doi.org/10.1093/neuros/nyy156 PMid:29688510 DOI: https://doi.org/10.1093/neuros/nyy156

Proescholdt MA, Macher C, Woertgen C, Brawanski A. Level of evidence in the literature concerning brain tumor resection. Clin Neurol Neurosurg. 2005;107(2):95-8. https://doi.org/10.1016/j.clineuro.2004.02.025 PMid:15708222 DOI: https://doi.org/10.1016/j.clineuro.2004.02.025

Manrique-Guzmán S, Herrada-Pineda T, Revilla-Pacheco F. Surgical management of glioblastoma. In: De Vleeschouwer S, editor. Glioblastoma. Ch. 12. Brisbane, AU: Codon Publications; 2017. https://doi.org/10.15586/codon.glioblastoma.2017.ch12 DOI: https://doi.org/10.15586/codon.glioblastoma.2017.ch12

Grossman SA, O’Neill A, Grunnet M, Mehta M, Pearlman JL, Wagner H, et al., Eastern Cooperative Oncology Group. Phase III study comparing three cycles of infusional carmustine and cisplatin followed by radiation therapy with radiation therapy and concurrent carmustine in patients with newly diagnosed supratentorial glioblastoma multiforme: Eastern Cooperative Oncology Group Trial 2394. J Clin Oncol. 2003;21(8):1485-91. https://doi.org/10.1200/jco.2003.10.035 PMid:12697871 DOI: https://doi.org/10.1200/JCO.2003.10.035

Ma X, Lv Y, Liu J, Wang D, Huang Q, Wang X, et al. Survival analysis of 205 patients with glioblastoma multiforme: Clinical characteristics, treatment and prognosis in China. J Clin Neurosci. 2009;16(12):1595-8. https://doi.org/10.1016/j.jocn.2009.02.036 PMid:19793663 DOI: https://doi.org/10.1016/j.jocn.2009.02.036

Barone TA, Gorski JW, Greenberg SJ, Plunkett RJ. Estrogen increases survival in an orthotopic model of glioblastoma. J Neurooncol. 2009;95(1):37-48. https://doi.org/10.1007/s11060-009-9904-6 PMid:19415456 DOI: https://doi.org/10.1007/s11060-009-9904-6

Li Q, Jedlicka A, Ahuja N, Gibbons MC, Baylin SB, Burger PC, Issa JP. Concordant methylation of the ER and N33 genes in glioblastoma multiforme. Oncogene. 1998;16(24):3197-202. https://doi.org/10.1038/sj.onc.1201831 PMid:9671399 DOI: https://doi.org/10.1038/sj.onc.1201831

Yu X, Jiang Y, Wei W, Cong P, Ding Y, Xiang L, et al. Androgen receptor signaling regulates growth of glioblastoma multiforme in men. Tumour Biol. 2015;36(2):967-72. https://doi.org/10.1007/s13277-014-2709-z PMid:25315188 DOI: https://doi.org/10.1007/s13277-014-2709-z

Tian M, Ma W, Chen Y, Yu Y, Zhu D, Shi J, et al. Impact of gender on the survival of patients with glioblastoma. Biosci Rep. 2018;38(6):BSR20180752. PMid:30305382 DOI: https://doi.org/10.1042/BSR20180752

Buckner JC. Factors influencing survival in high-grade gliomas. Sem Oncol. 2003;30(6):10-14. https://doi.org/10.1053/j.seminoncol.2003.11.031 PMid:14765378 DOI: https://doi.org/10.1053/j.seminoncol.2003.11.031

Karnofsky DA, Burchenal JH. The evaluation of chemotherapeutic agents in cancer. In: Macleod CM, editor. Evaluation Chemotherapy Agents. New York: Columbia University Press; 1949. p. 191-205.