Die Rolle der chirurgischen Re-Resektion für das Überleben beim rezidivierenden Glioblastom

Glioblastoma (GBM) is the most common malignant brain tumor in adults, characterized by a dismal prognosis and near-inevitable recurrence. The management of recurrent GBM is individualized, considering tumor location, patient function, and age. The role of repeated surgical resection in recurrent GBMs is not well-defined. This study aims to to evaluate the impact of repeated resection on progression-free survival (PFS) and overall survival (OS) in recurrent GBMs.

Data acquisition was conducted as a retrospective analysis. Our study included patients diagnosed with recurrent GBM who underwent repeated surgical resection at our department between January 1st, 2016, and December 31st, 2021. Demographic data, tumor size, Eastern Cooperative Oncology Group Performance Status (ECOG), treatment modalities, and extent of resection (classified by RANO criteria) were assessed. The Kaplan-Meier method was used to estimate OS and PFS as a function of time after first and second surgical re-resections.

Out of 197 recurrent GBM patients in the study, 86 underwent repeated resection—86 had one, and 20 had two surgical re-resections after initial surgery. The extent of the first repeated resection significantly correlated with overall survival (p=0.014) and progression-free survival (p=0.0073). The median progression-free survival varied: 259 days after complete re-resection, 147 days following subtotal resection, 176.5 days after near-total resection, and 118 days after partial resection. First repeat tumor resection was associated with increased PFS (p=0.0084) and OS (p=0.0023). In contrast, after second relapse, there is no statistically significant difference between second repeated surgery and treatment without surgery for overall survival (p=0.93) and progression-free survival (p=0.18). Multivariate analysis showed that concomitant treatment (OS: p=0.0213; PFS: p=0.00537) and MGMT promoter status (OS: p=0.0165; PFS: p=0.01243) remained statistically significant factors for survival.

While our results emphasize the important role of surgery in the treatment of the first recurrent GBM and concomitant treatment with a substantial association with extended overall survival (OS) and progression-free survival (PFS), the implications of subsequent repeated operations, particularly the second and third, remain ambiguous and may be subject to potential influences such as selection bias.