Extent of resection and its association with overall survival in newly diagnosed IDH wildtype glioblastoma treated with concomitant radiochemotherapy: a systematic review and meta-analysis
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Notice bibliographique
Résumé
Extent of resection (EOR) is a well-known prognostic factor in patients with newly diagnosed IDH-wildtype glioblastoma. However, reported survival times across resection categories vary between reports, and outcomes of submaximal or supratotal resection remain less well defined. We conducted a systematic review and meta-analysis on the association between EOR and overall survival (OS) in patients with newly diagnosed IDH-wildtype glioblastoma treated with chemoradiotherapy. Studies were included if OS was reported by EOR category. Risk ratios (RRs) for 1- and 2-year survival were pooled using a random-effects model. Study quality was assessed using the Newcastle-Ottawa Scale. Thirty-one studies involving 26,167 patients were included. Supramaximal resection (SupraMR) was associated with significantly improved 2-year survival compared to maximal CE resection (MR) (RR 0.70, 95% CI 0.60–0.81). Compared to submaximal resection (subMR), MR was associated with higher 1-year survival (RR 0.59, 95% CI 0.52–0.67) and 2-year survival (RR 0.82, 95% CI 0.77–0.87). Biopsy alone was associated with the poorest outcome. Findings remained robust in sensitivity analyses excluding SEER and RTOG cohorts. Increasing EOR seems to be associated with improved survival in newly diagnosed IDH-wildtype glioblastoma. SupraMR offers the greatest benefit, while submaximal resection appears to be more favorable than biopsy. These findings support the prognostic relevance of EOR and underscore the need for prospective studies with standardized resection classifications. The balanced summary of survival data for each resection class provided in this review can serve as a basis for effect estimation and sample size calculations in future trials. • Largest meta-analysis (n = 26,167) to date assessing extent of resection (EOR) in IDH-wildtype glioblastoma treated per the EORTC 26981/22981 protocol • Increasing EOR seems to be associated with significantly better survival at 1 and 2 years: Supramaximal resection > maximal CE resection > submaximal resection > biopsy • Supramaximal resection (SupraMR) improves 2-year survival compared to maximal CE resection, with median OS of 28.2 months vs 17.5 months. • Even submaximal resection offers better survival than biopsy, but the benefit is modest and potentially confounded • Sensitivity analyses show pooled results are robust even after removing large datasets (e.g., SEER, RTOG) • Study highlights urgent need for prospective trials using standardized resection definitions (e.g., RANO-Resect)
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Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,002 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découle