SURG-100. The favorable associations between age and supramaximal resection with outcome in glioblastoma – a report of the RANO resect group

Abstract BACKGROUND The oncological role of resection in elderly patients with glioblastoma remains controversial. We compared the prognostic impact of residual tumor volume between elderly and younger patients with (I) newly diagnosed and (II) recurrent glioblastoma to develop individualized surgical strategies and support age-adapted clinical trial design. METHODS The international RANO resect group retrospectively identified newly diagnosed and recurrent IDH-wildtype glioblastoma patients from ten neuro-oncological centers. Associations of residual tumor with molecular and clinical markers on survival were analyzed. Propensity-score matching and multivariable analyses were performed to minimize potential confounders. RESULTS 1260 (≥65 years: n=512) newly diagnosed glioblastoma patients were identified. Lower postoperative contrast-enhancing tumor volumes were favorably associated with survival on uni- and multivariate analyses; however, the effects on outcome were more pronounced in younger patients. In patients <65 years, supramaximal resection (RANO resect category 1) translated into more favorable survival (40 vs. 20 months, p=0.001) but not in elderly patients, in which maximal resection (RANO resect category 2) was associated with improved survival. In 310 patients with first glioblastoma recurrence (≥65 years: 92), maximal resection of contrast-enhancing tumor was associated with favorable outcomes regardless of age. Neither elderly nor younger patients had definitive evidence of favorable effects of supramaximal resection in the recurrent setting. Higher class resection (p=0.926) and age (p=0.861) were not associated with an increased incidence of postoperative neurological deficits. All findings were confirmed in propensity score-matched analyses. CONCLUSIONS While residual contrast-enhancing tumor was prognostic for outcome in both patients <65 and ≥65 years of age, more extensive resection was less beneficial in patients ≥65. Re-resection was associated with a favorable outcome when RANO class 2 (maximal) resection was performed, regardless of age. These findings emphasize that the RANO resect classification applies to both young and elderly patients and facilitates stratification in clinical trials regardless of age.

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Journal
Neuro-Oncology
Published
2025-11-01
DOI
https://doi.org/10.1093/neuonc/noaf201.1652
Primary Topic
Glioma Diagnosis and Treatment
Type
article
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article

SURG-100. The favorable associations between age and supramaximal resection with outcome in glioblastoma – a report of the RANO resect group

Jacob S. Young, Mitchel Stuart Berger, Christine Mau, Levin Häni et al.
Neuro-Oncology
Glioma Diagnosis and Treatment
article

SURG-100. The favorable associations between age and supramaximal resection with outcome in glioblastoma – a report of the RANO resect group

Jacob S. Young, Mitchel Stuart Berger, Christine Mau, Levin Häni, Martin J. van den Bent, Stefan Josef Grau, Joerg‐Christian Tonn, Daniel P. Cahill, Michael Weller, Patrick Yung Wen, Gilbert Youssef, Annette M. Molinaro, Philipp Karschnia, Shawn L. Hervey‐Jumper, Oliver Schnell, Nitin Tandon, Francesco Bruno, Jörg Dietrich, Nico Teske, Raymond Y. Huang, Antonio Dono, Jürgen Beck, Maximilian I. Ruge, Tommaso Sciortino, Lorenzo Bello, Yoshua Esquenazi, Roberta Rudà, Michael A. Vogelbaum, Stephanie T Juenger, Susan M. Chang
article en

Abstract

Abstract BACKGROUND The oncological role of resection in elderly patients with glioblastoma remains controversial. We compared the prognostic impact of residual tumor volume between elderly and younger patients with (I) newly diagnosed and (II) recurrent glioblastoma to develop individualized surgical strategies and support age-adapted clinical trial design. METHODS The international RANO resect group retrospectively identified newly diagnosed and recurrent IDH-wildtype glioblastoma patients from ten neuro-oncological centers. Associations of residual tumor with molecular and clinical markers on survival were analyzed. Propensity-score matching and multivariable analyses were performed to minimize potential confounders. RESULTS 1260 (≥65 years: n=512) newly diagnosed glioblastoma patients were identified. Lower postoperative contrast-enhancing tumor volumes were favorably associated with survival on uni- and multivariate analyses; however, the effects on outcome were more pronounced in younger patients. In patients <65 years, supramaximal resection (RANO resect category 1) translated into more favorable survival (40 vs. 20 months, p=0.001) but not in elderly patients, in which maximal resection (RANO resect category 2) was associated with improved survival. In 310 patients with first glioblastoma recurrence (≥65 years: 92), maximal resection of contrast-enhancing tumor was associated with favorable outcomes regardless of age. Neither elderly nor younger patients had definitive evidence of favorable effects of supramaximal resection in the recurrent setting. Higher class resection (p=0.926) and age (p=0.861) were not associated with an increased incidence of postoperative neurological deficits. All findings were confirmed in propensity score-matched analyses. CONCLUSIONS While residual contrast-enhancing tumor was prognostic for outcome in both patients <65 and ≥65 years of age, more extensive resection was less beneficial in patients ≥65. Re-resection was associated with a favorable outcome when RANO class 2 (maximal) resection was performed, regardless of age. These findings emphasize that the RANO resect classification applies to both young and elderly patients and facilitates stratification in clinical trials regardless of age.

Neuro-OncologyVol. 27(Supplement_5)
University of Bern (CH), Brigham and Women's Hospital (US), Harvard University (US), University of Freiburg (DE), University of California, San Francisco (US), University of Cologne (DE), Friedrich-Alexander-Universität Erlangen-Nürnberg (DE), University of Milan (IT), University of Zurich (CH), University Hospital of Bern (CH), University Medical Center Freiburg (DE), Moffitt Cancer Center (US), Massachusetts General Hospital (US), Universitätsklinikum Erlangen (DE), University Hospital of Zurich (CH), Dana-Farber Cancer Institute (US), Erasmus MC Cancer Institute (NL), Klinikum Fulda (DE), The University of Texas Health Science Center (US), University of Turin (IT), University of San Francisco (US), Universidade São Francisco (BR), Ludwig-Maximilians-Universität München (DE)
Openalex Percentile: Top 52%
Glioma Diagnosis and Treatment
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