SURG-18. ONCO-FUNCTIONAL OUTCOME AFTER RESECTION FOR ELOQUENT GLIOBLASTOMA (GLIOFO STUDY): A PROPENSITY-SCORED ANALYSIS OF AN INTERNATIONAL, MULTICENTER COHORT STUDY

Abstract

Abstract BACKGROUND Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood. We therefore developed a novel onco-functional outcome (OFO) classification and evaluated its benefit in subgroups based on age, preoperative neurological morbidity (NIHSS), and preoperative Karnofsky Performance Score (KPS). METHODS Propensity-score matching was used to match OFO 1 (no residual volume, no postoperative functional loss) vs. non-OFO 1 patients for the overall cohort and subgroups based on age, NIHSS, and KPS. Cox proportional-hazard regressions were performed to analyze the association between OFO class and postoperative neurological deficits, KPS deterioration, receipt of adjuvant therapy, overall survival, and progression-free survival. Logistic regressions were performed to analyze the predictive value of perioperative factors on OFO class. Findings Between 2010 and 2020, 858 patients with tumor resection for primary eloquent glioblastoma were included as the overall unmatched cohort. After matching, the overall matched cohort comprised of 512 patients: 256 received OFO 1 and 256 received non-OFO 1. In the overall matched cohort and matched subgroups, OFO 1 resulted in fewer postoperative neurological deficits, lower rates of postoperative KPS deterioration, higher rates of receipt of adjuvant therapy, longer overall survival (median 21.0 months vs. 13.0 months, p < 0.001), and longer progression-free survival (median 10.0 months vs. 7.5 months, p < 0.001). Patients who underwent awake craniotomy more often received OFO 1 (43.0% vs. 26.9%, p < 0.001), and awake craniotomy was an independent predictor for OFO 1 (OR 1.93, p = 0.0070). Interpretation OFO 1 is beneficial in patients with glioblastoma in eloquent areas to improve surgical outcomes, irrespective of age, preoperative NIHSS, or KPS. Furthermore, awake craniotomy was significantly associated with achieving this status. These results might aid neurosurgeons with their surgical decision making in individual patients.