Prognostic Factors of IDH Wild-Type Glioblastoma After Extensive Surgery: A Multimodal Atlas of Tumor Locations, Recurrences and Management

INTRODUCTION: Glioblastomas have poor prognosis despite aggressive treatment. Patterns of recurrence and overall survival (OS) can be very different. The population with complete resection having a so-called good prognosis can nevertheless present poor OS. Our purpose was to assess the OS and patterns of recurrence thanks to multimodal statistical maps in glioblastoma with large extent of resection (residue < 10 mL).

METHODS: adult patients presenting IDH wild-type glioblastoma between 2013 and 2019 were selected. Clinical data and MRI characteristics were collected. Preoperative, postoperative, and recurrence volumes were segmented and normalized in the MNI space to compute statistical maps. Log-rank test and Cox model were used to assess OS and prognosis factors.

RESULTS: 60 patients were included. Mean residual volume was 0.89 ± 2 mL. Median OS was 22.3 months (95% CI: (20-35)). Initial location in the corpus callosum was associated with low OS (317 vs. 783 days, HR = 0.46, p = 0.003). At recurrence, KPS > 90 and tumor volume < 10 mL were associated with higher OS ( p =0.006 and p = 0.05). Tumor contact with the SVZ as well as multifocal recurrence did not show any impact on the OS.

CONCLUSIONS: High OS can be obtained thanks to surgery with residual volume < 10 mL. Invasion of the corpus callosum at diagnosis is associated with a poor prognosis despite a large extent of resection. Results suggest that large resection near the SVZ might decrease its putative influence on OS.