Prognostic validation and refinement of a classification system for extent of resection in glioblastoma: A report of the RANO resect group
2003 Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system for glioblastoma was previously proposed based upon the absolute residual contrast-enhancing (CE) tumor (in cm 3 ) and the relative reduction of CE tu...
Saved in:
Published in | Journal of clinical oncology Vol. 40; no. 16_suppl; p. 2003 |
---|---|
Main Authors | , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
01.06.2022
|
Online Access | Get full text |
Cover
Loading…
Abstract | 2003
Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system for glioblastoma was previously proposed based upon the absolute residual contrast-enhancing (CE) tumor (in cm
3
) and the relative reduction of CE tumor (in percentage) on postoperative MRI. Class 0 was defined as ‘supramaximal CE resection’ (also including removal of non-CE tumor), class 1 as ‘maximal CE resection’, class 2 as ‘submaximal CE resection’, and class 3 as ‘biopsy’. We aimed to (I) explore the prognostic utility of the proposed classification system and (II) define how much non-CE tumor needs to be removed to translate into a survival benefit. Methods: An international Response Assessment in Neuro-Oncology (RANO) group was formed, entitled RANO resect. The members of the RANO resect group retrospectively searched the databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma. Clinical characteristics, volumetric information from pre- and postoperative MRI, and outcome were collected. Kaplan-Meier survival analysis and log-rank test were applied to calculate survival, and Cox’s proportional hazard regression model to adjust for multiple variables. Significance level was set at p ≤ 0.05. Results: We encountered 1021 patients with newly diagnosed glioblastoma, including 1008 IDHwt patients. 744 IDHwt patients were treated with radiochemotherapy per EORTC 26981/22981 following surgery. Among such homogenously treated patients, higher extent of resection was favorably associated with outcome: patients with ‘maximal CE resection’ (class 1) had superior outcome compared to patients with ‘submaximal CE resection’ (class 2) or ‘biopsy’ (class 3) (median OS: 20 versus 16 versus 10 months; p = 0.001). Similar findings were made when assessing progression (median PFS: 9 versus 8 versus 5 months; p = 0.001). Extensive resection of non-CE tumor (≥60% of non-CE tumor removed and ≤5 cm
3
residual non-CE tumor) provided an additional survival benefit in patients with complete CE resection (class 1), thus defining class 0 (‘supramaximal CE resection’) (median OS: 29 versus 20 months; p = 0.003). Smaller pre-operative tumor volumes were associated with larger extent of resection. The favorable prognostic effect of CE resection was conserved in a multivariate analysis when stratifying for molecular and clinical markers including pre-operative tumor volume and MGMT promotor status ( p = 0.001). Conclusions: The proposed classification system for extent of surgery in glioblastoma is highly prognostic and may serve for stratification and design of clinical trials. Removal of non-CE tumor beyond the CE tumor borders translates into additional survival benefit in glioblastomas, providing a rationale to explicitly denominate such a 'supramaximal CE resection.' |
---|---|
AbstractList | 2003
Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system for glioblastoma was previously proposed based upon the absolute residual contrast-enhancing (CE) tumor (in cm
3
) and the relative reduction of CE tumor (in percentage) on postoperative MRI. Class 0 was defined as ‘supramaximal CE resection’ (also including removal of non-CE tumor), class 1 as ‘maximal CE resection’, class 2 as ‘submaximal CE resection’, and class 3 as ‘biopsy’. We aimed to (I) explore the prognostic utility of the proposed classification system and (II) define how much non-CE tumor needs to be removed to translate into a survival benefit. Methods: An international Response Assessment in Neuro-Oncology (RANO) group was formed, entitled RANO resect. The members of the RANO resect group retrospectively searched the databases from seven neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma. Clinical characteristics, volumetric information from pre- and postoperative MRI, and outcome were collected. Kaplan-Meier survival analysis and log-rank test were applied to calculate survival, and Cox’s proportional hazard regression model to adjust for multiple variables. Significance level was set at p ≤ 0.05. Results: We encountered 1021 patients with newly diagnosed glioblastoma, including 1008 IDHwt patients. 744 IDHwt patients were treated with radiochemotherapy per EORTC 26981/22981 following surgery. Among such homogenously treated patients, higher extent of resection was favorably associated with outcome: patients with ‘maximal CE resection’ (class 1) had superior outcome compared to patients with ‘submaximal CE resection’ (class 2) or ‘biopsy’ (class 3) (median OS: 20 versus 16 versus 10 months; p = 0.001). Similar findings were made when assessing progression (median PFS: 9 versus 8 versus 5 months; p = 0.001). Extensive resection of non-CE tumor (≥60% of non-CE tumor removed and ≤5 cm
3
residual non-CE tumor) provided an additional survival benefit in patients with complete CE resection (class 1), thus defining class 0 (‘supramaximal CE resection’) (median OS: 29 versus 20 months; p = 0.003). Smaller pre-operative tumor volumes were associated with larger extent of resection. The favorable prognostic effect of CE resection was conserved in a multivariate analysis when stratifying for molecular and clinical markers including pre-operative tumor volume and MGMT promotor status ( p = 0.001). Conclusions: The proposed classification system for extent of surgery in glioblastoma is highly prognostic and may serve for stratification and design of clinical trials. Removal of non-CE tumor beyond the CE tumor borders translates into additional survival benefit in glioblastomas, providing a rationale to explicitly denominate such a 'supramaximal CE resection.' |
Author | Jünger, Stefanie T. Schnell, Oliver Bruno, Francesco Grau, Stefan Teske, Nico Young, Jacob S Weller, Michael Bello, Lorenzo Molinaro, Annette M. Esquenazi, Yoshua Karschnia, Philipp Ruda, Roberta Dono, Antonio Berger, Mitchel S. Chang, Susan Marina Tonn, Joerg Van Den Bent, Martin J. Häni, Levin Sciortino, Tommaso |
Author_xml | – sequence: 1 givenname: Philipp surname: Karschnia fullname: Karschnia, Philipp organization: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany – sequence: 2 givenname: Jacob S surname: Young fullname: Young, Jacob S organization: Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA – sequence: 3 givenname: Antonio surname: Dono fullname: Dono, Antonio organization: Department of Neurosurgery, University of Texas, Houston, TX – sequence: 4 givenname: Levin surname: Häni fullname: Häni, Levin organization: Department of Neurosurgery, University of Freiburg, Freiburg, Germany – sequence: 5 givenname: Tommaso surname: Sciortino fullname: Sciortino, Tommaso organization: Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy – sequence: 6 givenname: Francesco surname: Bruno fullname: Bruno, Francesco organization: Department of Neurology, Castelfranco Veneto/Treviso Hospitals, Turin, Italy – sequence: 7 givenname: Stefanie T. surname: Jünger fullname: Jünger, Stefanie T. organization: Department of Neurosurgery, University of Cologne, Cologne, Germany – sequence: 8 givenname: Nico surname: Teske fullname: Teske, Nico organization: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany – sequence: 9 givenname: Michael surname: Weller fullname: Weller, Michael organization: Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland – sequence: 10 givenname: Roberta surname: Ruda fullname: Ruda, Roberta organization: Department of Neurology, Castelfranco Veneto/Treviso Hospitals, Turin, Italy – sequence: 11 givenname: Lorenzo surname: Bello fullname: Bello, Lorenzo organization: Division for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy – sequence: 12 givenname: Oliver surname: Schnell fullname: Schnell, Oliver organization: Department of Neurosurgery, University of Freiburg, Freiburg, Germany – sequence: 13 givenname: Yoshua surname: Esquenazi fullname: Esquenazi, Yoshua organization: Department of Neurosurgery, University of Texas, Houston, TX – sequence: 14 givenname: Stefan surname: Grau fullname: Grau, Stefan organization: Department of Neurosurgery, University of Cologne, Cologne, Germany – sequence: 15 givenname: Annette M. surname: Molinaro fullname: Molinaro, Annette M. organization: Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA – sequence: 16 givenname: Mitchel S. surname: Berger fullname: Berger, Mitchel S. organization: Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA – sequence: 17 givenname: Susan Marina surname: Chang fullname: Chang, Susan Marina organization: Department of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, CA – sequence: 18 givenname: Martin J. surname: Van Den Bent fullname: Van Den Bent, Martin J. organization: Department of Neurology, Erasmus MC Cancer Institute, Rotterdam, Netherlands – sequence: 19 givenname: Joerg surname: Tonn fullname: Tonn, Joerg organization: Department of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany |
BookMark | eNotkNtKAzEURYNUsK3-Q_yAqblOpr6V4pViRRR8C5lMUiPTZEimYn_BrzZt5-nA3uscOGsCRj54A8A1RjNMELp5Xq5nBBEyYzkoZdp1XZsDRM_AGHMiCiE4H4ExEpQUuKKfF2CS0jdCmFWUj8HfawwbH1LvNPxRrWtU74KHyjcwGuu82Rrfw2ChgrpVKTnr9AlJ-9SbLbQhQvPbD1Q0yehj7TzctC7UeakPW3ULF7nsQjxi_ZeBb4uX9cDDTQy77hKcW9UmczXMKfi4v3tfPhar9cPTcrEqNEYlLYilyjBqNSVcU9RUFbXW0JIZVoqqEbyas5JzLqhiqq4Vp6QkokZZBiOGYjoF89NdHUNK-UvZRbdVcS8xkgepMkuVB6mS5WCQKg9S6T_VC3Eq |
CitedBy_id | crossref_primary_10_1093_nop_npac071 crossref_primary_10_1016_j_jconrel_2023_03_005 crossref_primary_10_1007_s12094_023_03245_y crossref_primary_10_1093_nop_npac051 crossref_primary_10_1007_s11060_023_04274_x crossref_primary_10_1200_JCO_22_01862 |
ContentType | Journal Article |
CorporateAuthor | RANO Resect Investigators |
CorporateAuthor_xml | – name: RANO Resect Investigators |
DBID | AAYXX CITATION |
DOI | 10.1200/JCO.2022.40.16_suppl.2003 |
DatabaseName | CrossRef |
DatabaseTitle | CrossRef |
DatabaseTitleList | CrossRef |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Medicine Pharmacy, Therapeutics, & Pharmacology |
EISSN | 1527-7755 |
EndPage | 2003 |
ExternalDocumentID | 10_1200_JCO_2022_40_16_suppl_2003 |
GroupedDBID | --- .55 0R~ 18M 2WC 34G 39C 4.4 53G 5GY 5RE 8F7 AAQQT AARDX AAWTL AAYEP AAYXX ABJNI ABOCM ACGFO ACGFS ACGUR ADBBV AEGXH AENEX AIAGR ALMA_UNASSIGNED_HOLDINGS AWKKM BAWUL C45 CITATION CS3 DIK EBS EJD F5P F9R FBNNL FD8 GX1 H13 HZ~ IH2 IPNFZ K-O KQ8 L7B LSO MJL N9A O9- OK1 OVD OWW P2P QTD R1G RHI RIG RLZ RUC SJN SV3 TEORI TR2 TWZ UDS VVN WH7 X7M YCJ YFH YQY |
ID | FETCH-LOGICAL-c1063-2f3ae43fc325c30d883ffe364e4678d75894655573a4abba532627b052742e313 |
ISSN | 0732-183X |
IngestDate | Fri Aug 23 01:53:30 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 16_suppl |
Language | English |
LinkModel | OpenURL |
MergedId | FETCHMERGED-LOGICAL-c1063-2f3ae43fc325c30d883ffe364e4678d75894655573a4abba532627b052742e313 |
PageCount | 1 |
ParticipantIDs | crossref_primary_10_1200_JCO_2022_40_16_suppl_2003 |
PublicationCentury | 2000 |
PublicationDate | 2022-06-01 |
PublicationDateYYYYMMDD | 2022-06-01 |
PublicationDate_xml | – month: 06 year: 2022 text: 2022-06-01 day: 01 |
PublicationDecade | 2020 |
PublicationTitle | Journal of clinical oncology |
PublicationYear | 2022 |
SSID | ssj0014835 |
Score | 2.4426734 |
Snippet | 2003
Background: Terminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system for... |
SourceID | crossref |
SourceType | Aggregation Database |
StartPage | 2003 |
Title | Prognostic validation and refinement of a classification system for extent of resection in glioblastoma: A report of the RANO resect group |
Volume | 40 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwnV1Lb9NAEF5FRaq4ICgg3lok1Evr4O7D3nCLUlBp1SZCqZSbtbuxq0jFrtr0UH4C_5J_wkxm_SgBAb1YyWo9sjNfZmZnZ75l7J1NCgiMAbxpbnSktHCRSRIXeeMNMmZp7zDfcXySHJyqw5me9Xo_OlVL10vX999-21dyF63CGOgVu2T_Q7ONUBiAz6BfuIKG4fpPOp5cVlgnh5yrIHZBxyNRxXheQPjYbPTveAySsSqIphB_M9F9YxZ8NQsbkXxd-3h2vqgc3LSsvlrqXqfdhbqm4MvwZBzu2Dlr8lfrUW7TeVmV_lYG_whW1Egfa9u0zsWaCToEe-3a7Ow-HRSOjAdgiqoGkqvdflVSozd4-rKby4BlcFNzFUxeKkUERmZG3imYZAFISonMt7bZRPFUYzPJrvAI1K4djmPZ8en11zV_Iego7NG4j4_TVzAUhPVbEV2O7l98Z1PRiGspgRuDo3GGojIFA0FURny090Q60Fh1uv_5qNnoUobOgK1ffJO9Dc_1_o9P1QmhOrHQ9CF7ENTLh4TIR6yXl1ts8ziUaWyx7QkRot_s8mnb33e1y7f5pKVKv3nMvrcI5i2COSCYtwjmVcEtv41gTgjmgGBOCMZZDYL5ouRdBH_gQ074xWmAX474DfP5Cr9P2Omnj9PRQRROB4n8HsTVkSikzZUsvBTay3hujCyKXCYqB99v5rAOHiA3oE6lVdY5q2GhIlIXayxOyOWefMo2yqrMnzGuYdVkZRGDYA8KEQNjrFbp3KcWHLoYPGei_sGzCyKByf6q8Bd3ueklu9_-L16xjeXldf4aot6le7PCzU-B263v |
link.rule.ids | 315,786,790,27955,27956 |
linkProvider | Flying Publisher |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Prognostic+validation+and+refinement+of+a+classification+system+for+extent+of+resection+in+glioblastoma%3A+A+report+of+the+RANO+resect+group&rft.jtitle=Journal+of+clinical+oncology&rft.au=Karschnia%2C+Philipp&rft.au=Young%2C+Jacob+S&rft.au=Dono%2C+Antonio&rft.au=H%C3%A4ni%2C+Levin&rft.date=2022-06-01&rft.issn=0732-183X&rft.eissn=1527-7755&rft.volume=40&rft.issue=16_suppl&rft.spage=2003&rft.epage=2003&rft_id=info:doi/10.1200%2FJCO.2022.40.16_suppl.2003&rft.externalDBID=n%2Fa&rft.externalDocID=10_1200_JCO_2022_40_16_suppl_2003 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=0732-183X&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=0732-183X&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=0732-183X&client=summon |