Survival benefit of lobectomy for glioblastoma: moving towards radical supramaximal resection

J Neurooncol. 2020 Jul;148(3):501-508. doi: 10.1007/s11060-020-03541-5. Epub 2020 Jul 5.

Abstract

Purpose: Extent of resection remains a paramount prognostic factor for long-term outcomes for glioblastoma. As such, supramaximal resection or anatomic lobectomy have been offered for non-eloquent glioblastoma in an attempt to improve overall survival. Here, we conduct a propensity-matched analysis of patients with non-eloquent glioblastoma who underwent either lobectomy or gross total resection of lesion to investigate the efficacy of supramaximal resection of glioblastoma.

Methods: Patients who underwent initial surgery for gross total resection or lobectomy for non-eloquent glioblastoma at our tertiary care referral center from 2010 to 2019 were included for this propensity-matched survival analysis. Propensity scores were generated with the following covariates: age, location, preoperative KPS, product of perpendicular maximal tumor diameters, and product of perpendicular FLAIR signal diameters. Inverse probability of treatment weighting (IPTW) with generated propensity scores was used to compare progression-free survival and overall survival.

Results: Sixty-nine patients were identified who underwent initial resection of glioblastoma for non-eloquent glioblastoma from 2010 to 2019 (GTR = 37, lobectomy = 32). Using IPTW, overall survival (30.7 vs. 14.1 months) and progression-free survival (17.2 vs. 8.1 months were significantly higher in the lobectomy cohort compared to the GTR group (p < 0.001). There was no significant difference in pre-op or post-op KPS or complication rates between the two groups.

Conclusion: Our propensity-matched study suggests that lobectomy for non-eloquent glioblastoma confers an added survival benefit compared to GTR alone. For patients with non-eloquent glioblastoma, a supramaximal resection by means of an anatomic lobectomy should be considered as a primary surgical treatment in select patients if feasible.

Keywords: Brain tumor; Glioma; Gross total resection; Lobectomy; Outcomes.

MeSH terms

  • Aged
  • Brain Neoplasms / mortality*
  • Brain Neoplasms / pathology
  • Brain Neoplasms / surgery
  • Craniotomy / mortality*
  • Female
  • Follow-Up Studies
  • Glioblastoma / mortality*
  • Glioblastoma / pathology
  • Glioblastoma / surgery
  • Humans
  • Male
  • Middle Aged
  • Neurosurgical Procedures / mortality*
  • Prognosis
  • Retrospective Studies
  • Survival Rate