Onco-functional outcome after resection for eloquent glioblastoma (OFO): A propensity-score matched analysis of an international, multicentre, cohort study.

in European journal of cancer (Oxford, England : 1990) by Jasper Kees Wim Gerritsen, Rania Angelia Mekary, Dana Pisică, Rosa Hanne Zwarthoed, John Laws Kilgallon, Noah Lee Nawabi, Charissa Alissa Cassandra Jessurun, Georges Versyck, Ahmed Moussa, Hicham Bouhaddou, Koen Pepijn Pruijn, Fleur Louise Fisher, Emma Larivière, Lien Solie, Alfred Kloet, Rishi Nandoe Tewarie, Joost Willem Schouten, Eelke Marijn Bos, Clemens Maria Franciscus Dirven, Martin Jacques van den Bent, Susan Marina Chang, Timothy Richard Smith, Marike Lianne Daphne Broekman, Arnaud Jean Pierre Edouard Vincent, Prof Steven De Vleeschouwer

TLDR

  • The study aimed to develop a new way to measure how well patients with glioblastoma (a type of brain tumor) did after surgery. The researchers looked at how well patients did based on two goals: oncological (related to the tumor) and functional (related to how well the patient could move and function). They found that a new way of measuring these goals together (called onco-functional outcome or OFO) was better than looking at them separately. The study also found that preventing deficits (meaning not losing function) was more important than complete surgery for achieving the optimal outcome. The study also found that safe surgery was important for patients with a low KPS (a measure of how well a patient can function) to qualify for adjuvant treatment (like chemotherapy or radiation). The study also found that awake craniotomy (a type of surgery where the patient is awake) was more likely to lead to the optimal outcome than asleep surgery.

Abstract

The combined impact of complete resection (oncological goal) and no functional loss (functional goal) in glioblastoma subgroups is currently unknown. This study aimed to develop a novel onco-functional outcome (OFO) to merge these two goals into one outcome, resulting in four classes: complete without deficits (OFO1), incomplete without deficits (OFO2), complete with deficits (OFO3), or incomplete with deficits (OFO4). Between 2010-2020, 858 patients with tumor resection for eloquent glioblastoma were included. We analyzed the impact of OFO class on postoperative surgical outcomes using Cox proportional-hazards models with hazard ratios (HR) or logistic regression with odds ratios (OR), followed by specific subgroup analyses. We developed a risk model to predict OFO class preoperatively using logistic regression. The OFO classification stratified the four OFO classes for overall survival (OS:19.0 versus 14.0 versus 12.0 versus 9.0 months), progression-free survival (PFS), and adjuvant therapy. OFO1 was associated with improved OS [HR= 0.67, (0.55-0.81); p < 0.001], and PFS [HR = 0.68, (0.57-0.81); p < 0.001] in the overall cohort and all clinical and molecular subgroups, except for MGMT-unmethylated tumors; and higher rate of adjuvant therapy [OR= 2.81, (1.71-4.84);p < 0.001]. In patients≥ 70 years, only OFO1 improved their survival outcomes. Safe surgery was especially important in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Awake craniotomy more often led to OFO1 compared to asleep resection [OR = 1.93, (1.19-3.14); p = 0.008]. OFO1 was associated with improved OS, PFS, and receipt of adjuvant therapy in all glioblastoma patients with IDH-wildtype and MGMT-methylated tumors. Awake craniotomy was associated with achieving this optimal OFO status. Preventing deficits was more important than complete surgery.

Overview

  • The study aimed to develop a novel onco-functional outcome (OFO) to merge the oncological and functional goals in glioblastoma subgroups. The OFO classification stratified the four OFO classes for overall survival (OS), progression-free survival (PFS), and adjuvant therapy. The study included 858 patients with tumor resection for eloquent glioblastoma between 2010-2020. The authors analyzed the impact of OFO class on postoperative surgical outcomes using Cox proportional-hazards models with hazard ratios (HR) or logistic regression with odds ratios (OR), followed by specific subgroup analyses. They also developed a risk model to predict OFO class preoperatively using logistic regression. The study found that OFO1 was associated with improved OS, PFS, and receipt of adjuvant therapy in the overall cohort and all clinical and molecular subgroups, except for MGMT-unmethylated tumors. In patients≥ 70 years, only OFO1 improved their survival outcomes. Safe surgery was especially important in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Awake craniotomy more often led to OFO1 compared to asleep resection. The study highlights the importance of preventing deficits in achieving optimal outcomes in glioblastoma patients. Preventing deficits was more important than complete surgery.

Comparative Analysis & Findings

  • The study found that OFO1 was associated with improved OS, PFS, and receipt of adjuvant therapy in the overall cohort and all clinical and molecular subgroups, except for MGMT-unmethylated tumors. In patients≥ 70 years, only OFO1 improved their survival outcomes. Safe surgery was especially important in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Awake craniotomy more often led to OFO1 compared to asleep resection. The study highlights the importance of preventing deficits in achieving optimal outcomes in glioblastoma patients. Preventing deficits was more important than complete surgery.

Implications and Future Directions

  • The study's findings suggest that the onco-functional outcome (OFO) is a useful tool for stratifying glioblastoma patients based on their oncological and functional goals. The study also highlights the importance of preventing deficits in achieving optimal outcomes in glioblastoma patients. Future research should focus on validating the OFO classification in larger cohorts and exploring its potential for personalized treatment planning. The study also suggests that safe surgery is crucial in patients with a preoperative KPS ≤ 80 to qualify for adjuvant treatment. Future research should investigate the optimal surgical approach for achieving the optimal onco-functional outcome in glioblastoma patients.
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