Supratotal Resection Versus Gross Total Resection for Isocitrate Dehydrogenase-Wildtype Glioblastoma and Grade 4 Isocitrate Dehydrogenase-Mutant Astrocytoma: Meta-Analysis of Individual Patient Data

Abstract

BACKGROUND AND OBJECTIVES: IDH-wildtype glioblastoma multiforme (GBM) and grade 4 IDH-mutant astrocytoma are challenging to manage in oncology. This study explores the contrast between gross total resection (GTR) and supratotal resection (SupTR) for IDH-wildtype GBM and grade 4 IDH-mutant astrocytoma, aiming to summarize their influence on crucial clinical outcomes. METHODS: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. PubMed, Web of Science, Embase, Scopus, and Cochrane were searched for articles until December 2023. RESULTS: Ten studies were included, involving 1043 patients with IDH-wildtype GBM and grade 4 IDH-mutant astrocytoma who underwent GTR or SupTR. SupTR demonstrated a favorable impact on long-term overall survival (OS) and progression-free survival (PFS) compared with GTR. The hazard ratio for OS was 0.655 (95% CI: 0.5703-0.7522, P < .0001), and for PFS, it was 0.732 (95% CI: 0.6279-0.8540, P = .0001) in the long-term analysis. Short-term analysis (18 months) reinforced the superiority of SupTR, with a hazard ratio for OS of 0.544 (95% CI: 0.450-0.659, P < .0001), and for PFS, it was 0.697 (95% CI: 0.586-0.830, P < .0001) in this timespan. CONCLUSION: SupTR appears to be a promising alternative to GTR for treating IDH-wildtype GBM and grade 4 IDH-mutant astrocytoma, showing improved OS and PFS outcomes. More robust studies that are less susceptible to bias are needed to strengthen this conclusion.