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
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.025 |
| Bibliometrics | 0.003 | 0.005 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".