Background

The inevitable recurrence of glioblastoma (GBM) results in patients often undergoing multiple resections with questionable benefit to overall survival (OS).

Objective

To systematically review and analyze prior studies examining the potential added benefit of repeat resection (RR) in recurrent GBM.

Methods

We performed a PRISMA-compliant systematic review of literature published between 1969 to 2019 involving patients undergoing RR at GBM recurrence.

Results

The search yielded 3994 non-duplicate citations. Final abstraction included 43 articles, with 2 level II and 41 level III studies. The earliest paper we included was published in 1987 [1], and 35 identified papers (81.4%) were published within the last 10 years. The survival data of 9236 patients (55% male) were analyzed, with a median age of 56; 3726 patients underwent RR. In 31 studies with a comparable single-surgery-only cohort, 20 articles reported a statistically significant increase in OS with RR, 7 reported nonsignificant trends toward increased OS with RR, and 4 reported no significant increase in OS with RR. Twenty-two articles with multivariate analyses of Karnofsky performance scores and 17 articles with extent-of-resection reported these as significant prognostic factors of OS. In 26 studies, median OS among all patients was 17.85 months inclusive of median OS following RR totaling 9.6 months. Notably, in 10 studies with data on subsequent progressions (2+ recurrences), 6 studies reported significant increases in OS with subsequent repeat resection (sRR) compared to those not undergoing sRR.

Conclusions

Recurrent GBM presents a treatment challenge. There appears to be an OS benefit for RR upon first recurrence as well as sRR. Such findings warrant further investigation of the potential benefits of continued surgical intervention after subsequent progressions of GBM.

中文翻译：

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评估重复切除在复发性胶质母细胞瘤中的疗效：系统评价。

背景

胶质母细胞瘤（GBM）不可避免的复发会导致患者经常进行多次切除术，但对总体生存率（OS）的益处尚有疑问。

目的

为了系统地回顾和分析先前的研究，这些研究检查了复发性GBM中重复切除术（RR）的潜在附加益处。

方法

我们对1969年至2019年之间发表的涉及GBM复发时接受RR的患者的文献进行了PRISMA兼容的系统评价。

结果

该搜索产生了3994次非重复引用。最终的摘要包括43篇文章，进行了2项II级和41项III级研究。我们收录的最早论文发表于1987年[1]，最近10年内发表了35篇论文（占81.4％）。分析了9236名患者（男性55％）的生存数据，中位年龄为56岁；3726例患者接受了RR。在具有可比性单手术队列的31项研究中，有20篇文章报道了RR引起的OS发生率有统计学意义的显着增加，7篇报道了RR引起的OS发生率无显着趋势，而4篇报道了RR引起的OS率没有显着增加。22篇对Karnofsky性能评分进行多变量分析的文章和17篇对切除范围的文章将其作为OS的重要预后因素。在26项研究中，所有患者的OS中位数为17。85个月（包括RR后的中位OS）总计9.6个月。值得注意的是，在10项具有后续进展数据（2+复发）的研究中，有6项研究报告与未进行sRR的患者相比，其后进行了重复切除术（sRR）的OS显着增加。

结论

复发性GBM带来了治疗挑战。首次复发以及sRR似乎对RR有OS益处。这些发现值得进一步研究GBM后续进展后继续进行外科手术的潜在益处。