The Impact of Extent of Resection on the Prognosis of Glioblastoma Multiforme: A Systematic Review and Meta-analysis

Abstract

Purpose: 
 To investigate the predictor factors of mortality describing the prognosis of primary surgical resection of Glioblastoma Multiforme (GBM).
 Materials and Methods:
 A systemic search was conducted from electronic databases (PubMed/Medline, Cochrane Library, and Google Scholar) from inception to 12th September 2021. All statistical analysis was conducted in Review Manager 5.4.1. Studies meeting inclusion criteria were selected. A random-effect model was used when heterogeneity was seen to pool the studies, and the result were reported in the Hazards Ratio (HR) and corresponding 95% Confidence interval (CI).
 Result:
 Twenty-three cohort studies were selected for meta-analysis. There was statistically significant effect of extent of resection on prognosis of surgery in GBM patients (HR= 0.90 [0.86, 0.95]; p< 0.0001; I2= 96%), male gender (HR= 1.19 [1.06, 1.34]; p= 0.002; I2= 0%) and decrease Karnofsky Performance Status (HR= 0.97 [0.95, 0.99]; p= 0.003; I2= 90%). Age and tumor volume was also analyzed in the study.
 Conclusion:
 The results of our meta-analysis suggested that age, gender, pre-operative KPS score and extent of resection have significant effects on the post-surgical mortality rate, therefore, these factors can be used significant predictor of mortality in GBM patients.

Case Report: Impact of gross total resection on survival in glioblastoma

“…The glioblastoma (GBM), which is considered to be the most common kind of malignant primary brain tumor, is categorised as a high-grade glioma that has been identified. 6 The high invasiveness of glioblastoma (GBM) poses a substantial obstacle in achieving gross total resection (GTR), mostly because to the persistent character of microscopic tumors. This persistent nature eventually contributes to the unfavourable prognosis associated with this illness.…”

“…Despite the progress made in treatment modalities, the median survival duration for patients with glioblastoma multiforme (GBM) continues to be less than 15 months. 1,6,9 Stupp et al presented the findings of an NCIC-EORTC randomised experiment in 2005. Temozolomide-radiotherapy was compared to radical radiation alone for glioblastoma treatment in this research.…”

“…4,5 An EOR that is greater than 98% of the tumor mass has been shown to correspond with a more favourable prognosis, as demonstrated by research conducted by Lacroix et al and following studies. [6][7][8][9] Surgical tumor removal, radiation, and chemotherapy with Temozolomide-based adjuvant treatment are routine.…”