Prognostic Factors Affecting Survival After Re-resection in Recurrent Glioblastoma

Overview

This meta-analysis evaluates key prognostic factors influencing survival outcomes following re-resection in recurrent glioblastoma (GBM). It identifies patient and tumor characteristics associated with improved survival, supporting more personalized treatment strategies for recurrent GBM.

Background

Glioblastoma (GBM) is the most common primary malignant brain tumor with poor prognosis despite standard initial treatment involving maximal safe resection and chemoradiotherapy. Recurrence is almost inevitable, and management of recurrent GBM remains challenging with no standardized approach. Repeat resection is performed in a subset of patients, but its survival benefit and the prognostic factors influencing outcomes after re-resection are not well defined. This meta-analysis systematically assesses these factors to guide clinical decision-making.

Data Highlights

Key Findings

• Gross total re-resection is significantly associated with improved survival compared to subtotal resection or biopsy alone.
• Higher preoperative Karnofsky Performance Status (KPS) predicts better survival outcomes following re-resection.
• MGMT promoter methylation status is a favorable prognostic biomarker linked to prolonged survival after re-resection.
• Older patient age is associated with poorer survival outcomes post re-resection.
• Sensitivity analyses restricted to IDH-wildtype glioblastoma patients confirm the robustness of these prognostic associations.

Clinical Implications

These findings support considering gross total re-resection in appropriately selected patients with recurrent GBM, particularly those with good functional status and favorable molecular profiles such as MGMT methylation. Patient age and performance status should be carefully evaluated to optimize individualized treatment planning. Molecular characterization including IDH and MGMT status is important for prognostication and therapeutic decision-making in recurrent GBM.

Conclusion

Re-resection can confer a survival benefit in recurrent glioblastoma when performed in patients with favorable prognostic factors including high KPS, MGMT promoter methylation, and younger age. This meta-analysis provides quantitative evidence to guide personalized management strategies in this challenging clinical scenario.

References

1. EANO Guidelines 2021 -- Management of Recurrent Glioblastoma
2. Stupp et al. 2005 -- Radiotherapy plus Concomitant and Adjuvant Temozolomide for Glioblastoma
3. WHO Classification 2021 -- CNS Tumors
4. PRISMA 2020 Statement -- Systematic Review Reporting Standards
5. ROBINS-I Tool -- Risk of Bias Assessment in Non-Randomized Studies