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Supramaximal resection: retrospective study on IDH-wildtype Glioblastomas based on the new RANO-Resect classification

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Abstract

Background

The prognostic value of the extent of resection in the management of Glioblastoma is a long-debated topic, recently widened by the 2022 RANO-Resect Classification, which advocates for the resection of the non-enhancing disease surrounding the main core of tumors (supramaximal resection, SUPR) to achieve additional survival benefits. We conducted a retrospective analysis to corroborate the role of SUPR by the RANO-Resect Classification in a single center, homogenous cohort of patients.

Methods

Records of patients operated for WHO-2021 Glioblastomas at our institution between 2007 and 2018 were retrospectively reviewed; volumetric data of resected lesions were computed and classified by RANO-Resect criteria. Survival and correlation analyses were conducted excluding patients below near-total resection.

Results

117 patients met the inclusion criteria, encompassing 45 near-total resections (NTR), 31 complete resections (CR), and 41 SUPR. Median progression-free and overall survival were 11 and 15 months for NTR, 13 and 17 months or CR, 20 and 24 months for SUPR, respectively (p < 0.001), with inverse correlation observed between survival and FLAIR residual volume (r -0.28). SUPR was not significantly associated with larger preoperative volumes or higher rates of postoperative deficits, although it was less associated with preoperative neurological deficits (OR 3.37, p = 0.003). The impact of SUPR on OS varied between MGMT unmethylated (HR 0.606, p = 0.044) and methylated (HR 0.273, p = 0.002) patient groups.

Conclusions

Results of the present study support the validity of supramaximal resection by the new RANO-Resect classification, also highlighting a possible surgical difference between tumors with methylated and unmethylated MGMT promoter.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for the present work.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Milan, Pieve Emanuele, Italy

    Maria Pia Tropeano, Luca Raspagliesi, Beatrice Claudia Bono, Ali Baram, Matteo Simonelli, Marta Scorsetti, Marco Riva, Letterio Salvatore Politi & Federico Pessina

  2. Neurosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Maria Pia Tropeano, Luca Raspagliesi, Beatrice Claudia Bono, Ali Baram, Zefferino Rossini, Andrea Franzini & Federico Pessina

  3. Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Pierina Navarria, Elena Clerici, Luisa Bellu & Marta Scorsetti

  4. Department of Medical Oncology and Hematology, Humanitas Clinical and Research Center - IRCCS, Humanitas Cancer Center, Milan, Italy

    Matteo Simonelli

  5. Department of Neuroradiology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Milan, Rozzano, Italy

    Letterio Salvatore Politi

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  1. Maria Pia Tropeano
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Correspondence to Luca Raspagliesi.

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The Authors declare no financial or non-financial interests which are directly or indirectly linked to the present work.

Ethics approval

All patients were treated in accordance with the principles of the Helsinki Declaration. This retrospective study was submitted to the local Ethics Committee and received approval with number 49/23.

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All patients gave their written informed consent for both surgery and the use of their data for scientific purposes.

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Tropeano, M.P., Raspagliesi, L., Bono, B.C. et al. Supramaximal resection: retrospective study on IDH-wildtype Glioblastomas based on the new RANO-Resect classification. Acta Neurochir 166, 196 (2024). https://doi.org/10.1007/s00701-024-06090-2

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