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Purpose <p>The prognostic role of repeat resection in IDH-mutant lower-grade glioma remains insufficiently defined. This observational single-center study investigated whether resection at 1<sup>st</sup> recurrence was associated with (progression-free) survival after recurrence (PFS-2; SAR) and evaluated functional outcomes.</p> Methods <p>We retrospectively analyzed 148 molecularly characterized IDH-mutant astrocytoma and oligodendroglioma patients, WHO grade 2 and 3, undergoing resection (<i>n</i> = 50) or non-surgical treatment (<i>n</i> = 98) at 1<sup>st</sup> recurrence between 2001 and 2023. In surgical cases, FLAIR tumor volumes (TV) were assessed volumetrically. Prognostic factors were identified by log-rank tests and multivariable Cox proportional hazards regression. Median follow-up was 140 months.</p> Results <p>Female sex (<i>p</i> = 0.005), frontal tumors (<i>p</i> = 0.029) and iterative resections (<i>p</i> = 0.025) were more frequent in surgical patients, while non-surgical patients received more systemic treatment. Functional status (KPS, NANO) and tumor characteristics (histology, WHO grade) were balanced. In multivariable analysis, re-resection was associated with prolonged PFS-2 (<i>p</i> = 0.029, HR = 0.560, 95% CI 0.332–0.944), but not with SAR. In surgical cases, median pre- and postoperative TVs were 19.75 cm<sup>3</sup> and 4.545 cm<sup>3</sup> (<i>p</i> &lt; 0.00001). PFS-2 was significantly prolonged in patients without (<i>n</i> = 12) compared to surgical patients with residual TV (<i>n</i> = 38; <i>p</i> = 0.022) and all patients with residual disease, including non-surgical cases (<i>n</i> = 136; <i>p</i> = 0.007). Following re-resection, a permanent deficit remained in 1 patient (2%). Functional status was preserved, with stable rates of KPS ≥90% and NANO = 0 at 7 days and 3 months postoperatively.</p> Conclusion <p>In this cohort of IDH-mutant lower-grade gliomas, repeat resection at 1<sup>st</sup> recurrence was safe and associated with prolonged PFS-2, especially when GTR was achieved, supporting its relevance in multimodal treatment.</p>

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Prognostic relevance of resection at first recurrence in isocitrate dehydrogenase mutant lower-grade glioma: results from a retrospective, single-center, volumetric analysis

  • 期刊论文

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  • 发表日期：

    2026年3月11日

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  • Christine Jungk,
  • Karla Goepfert,
  • Mara Gluszak,
  • Karim Marhaba,
  • Philip Dao Trong,
  • Sandro M. Krieg,
  • Martin Bendszus,
  • Felix Sahm,
  • Andreas W. Unterberg

摘要

Purpose

The prognostic role of repeat resection in IDH-mutant lower-grade glioma remains insufficiently defined. This observational single-center study investigated whether resection at 1st recurrence was associated with (progression-free) survival after recurrence (PFS-2; SAR) and evaluated functional outcomes.

Methods

We retrospectively analyzed 148 molecularly characterized IDH-mutant astrocytoma and oligodendroglioma patients, WHO grade 2 and 3, undergoing resection (n = 50) or non-surgical treatment (n = 98) at 1st recurrence between 2001 and 2023. In surgical cases, FLAIR tumor volumes (TV) were assessed volumetrically. Prognostic factors were identified by log-rank tests and multivariable Cox proportional hazards regression. Median follow-up was 140 months.

Results

Female sex (p = 0.005), frontal tumors (p = 0.029) and iterative resections (p = 0.025) were more frequent in surgical patients, while non-surgical patients received more systemic treatment. Functional status (KPS, NANO) and tumor characteristics (histology, WHO grade) were balanced. In multivariable analysis, re-resection was associated with prolonged PFS-2 (p = 0.029, HR = 0.560, 95% CI 0.332–0.944), but not with SAR. In surgical cases, median pre- and postoperative TVs were 19.75 cm3 and 4.545 cm3 (p < 0.00001). PFS-2 was significantly prolonged in patients without (n = 12) compared to surgical patients with residual TV (n = 38; p = 0.022) and all patients with residual disease, including non-surgical cases (n = 136; p = 0.007). Following re-resection, a permanent deficit remained in 1 patient (2%). Functional status was preserved, with stable rates of KPS ≥90% and NANO = 0 at 7 days and 3 months postoperatively.

Conclusion

In this cohort of IDH-mutant lower-grade gliomas, repeat resection at 1st recurrence was safe and associated with prolonged PFS-2, especially when GTR was achieved, supporting its relevance in multimodal treatment.