Prognostic study on survival of insular glioblastoma based on the resection classification criteria of response assessment in neuro-oncology
MA Peiheng
ZHAO Chongshun
LI Xiaopeng
PAN Yunsong
QIAN Zenghui
ZHANG Zhong
ZHANG Wei
Abstract：Objective To explore the application of the Response Assessment in Neuro-Oncology(RANO)resection classification in insular glioblastoma(GBM)and the factors influencing prognosis.Methods Clinical data of 86 patients with insular GBM from the Chinese Glioma Genome Atlas(CGGA)database were analyzed retrospectively.All the patients underwent craniotomy for tumor resection,with 73 receiving postoperative radiotherapy,6 without radiotherapy,7 missing data and 69 receiving chemotherapy,9 without chemotherapy,8 missing data.The clinical characteristics of all the patients were summarized,including the presence of a history of epilepsy,O6-methylguanine-DNA methyltransferase(MGMT)methylation status,preoperative/postoperative enhanced tumor volume,and RANO resection classification.The Kaplan-Meier method was used to analyze the progression-free survival(PFS)and overall survival(OS)of all the patients.Univariate Cox regression analysis for OS and PFS was performed to screen factors associated with OS and PFS,and further multivariate Cox regression analysis was used to identify the clinical factors influencing PFS and OS.Results Among the 86 patients,24 underwent RANO class 1 resection,58 underwent RANO class 2 resection,and 4 underwent RANO class 3 resection.MGMT promoter methylation was detected in 29 patients(33.7%),unmethylated in 53(61.6%),and missing in 4(4.7%).Kaplan-Meier analysis showed that the median OS and median PFS in the RANO class 1 resection group were 544 days and 527 days,respectively;the median OS and median PFS in the RANO class 2 resection group were 694 days and 502 days,respectively;the median OS and median PFS in the RANO class 3 resection group were 428 days and 210 days,respectively.No significant differences in OS or PFS were observed between the RANO class 1 and class 2 resection groups(both P>0.05).Compared with RANO class 1 and class 2,RANO class 3 resections showed significantly shorter OS(Class 3 vs.Class 1:P=0.05;Class 3 vs.Class 2:P=0.004)and PFS(Class 3 vs.Class 1:P=0.006;Class 3 vs.Class 2:P<0.001).Univariate Cox regression identified MGMT promoter methylation status,age,RANO resection classification,telomerase reverse transcriptase(TERT)promoter mutation status,and histopathology as factors influencing OS(all P<0.05).Multivariate Cox regression revealed MGMT promoter methylation,age,and RANO class 2 resection as independent protective factors for OS(all P<0.05),while MGMT promoter methylation,age and RANO class 2 and RANO class 1 resections were independent protective factors for PFS(all P<0.05).Conclusions With advances in microsurgical techniques and the development of molecular therapies,the prognosis of insular GBM has improved to a certain extent.The analysis showed that compared with RANO class 3 resection,RANO class 1 and class 2 resections significantly improve patient prognosis,indicating the importance of complete resection of MRI T1-enhancing lesions in insular GBM.However,excessive pursuit of resection of the preoperative edematous area(MRI T2 hyperintense area)should be avoided to prevent neglect of neurological function protection.
Keywords：gliomainsulaResponse Assessment in Neuro-Oncology classificationsurvival prognosis
Publication Date：2026-01-20
Online Publishing Date：2026-02-07(First online date of this platform, not the publication date of the document)
Pages：7( 21-27 )