Evidence map›Paper›PMID 35961053›Full record

ArticleNeuro-oncology2023

Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group.

Philipp Karschnia, Jacob S Young, Antonio Dono, Levin Häni, Tommaso Sciortino, Francesco Bruno, Stephanie T Juenger, Nico Teske, Ramin A Morshed, Alexander F Haddad and 18 more

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Neuro-oncology, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT07021339 (Randomized, Controlled Trial of Anterior Temporal Lobectomy Versus Gross Total Resection in Newly-diagnosed Temporal Glioblastoma), which is not on this map. Cited by 273 papers, 9 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
273citing papers in PubMed, 9 pooled it
43.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT07021339 phase3recruitingnot on this mapstarted 2024, after this paper: background citation

Randomized, Controlled Trial of Anterior Temporal Lobectomy Versus Gross Total Resection in Newly-diagnosed Temporal Glioblastoma (ATLAS/NOA-29)

TypeinterventionalSponsorUniversity Hospital, BonnRan2024 to 2031Enrolled178ConditionsNewly-diagnosed Glioblastoma, Temporal LobeArmsAnterior temporal lobectomy (ATL), Gross Total Resection (GTR)
3 · Its place in the literature

Who cites it

273 citing papers in PubMed, 9 syntheses or guidelines pooled it, 305 citations in OpenAlex.

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213 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors at 14 institutions in 5 countries.

Philipp KarschniaDepartment of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.ORCID 0000-0002-1254-5310
Jacob S YoungDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Antonio DonoDepartment of Neurosurgery, McGovern Medical School at UT Health Houston , Houston, Texas, USA.ORCID 0000-0002-8041-8399
Levin HäniDepartment of Neurosurgery, University of Freiburg , Freiburg, Germany.
Tommaso SciortinoDivision for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Francesco BrunoDivision of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy.ORCID 0000-0001-8087-5293
Stephanie T JuengerDepartment of Neurosurgery, University of Cologne , Cologne, Germany.
Nico TeskeDepartment of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
Ramin A MorshedDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Alexander F HaddadDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Yalan ZhangDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Sophia StoeckleinDepartment of Radiology, University Hospital, LMU Munich , Munich, Germany.
Michael WellerDepartment of Neurology, University Hospital and University of Zurich, Zurich, Switzerland.ORCID 0000-0002-1748-174X
Michael A VogelbaumDepartment of NeuroOncology, Moffitt Cancer Center, Tampa, Florida, USA.
Juergen BeckDepartment of Neurosurgery, University of Freiburg , Freiburg, Germany.
Nitin TandonDepartment of Neurosurgery, McGovern Medical School at UT Health Houston , Houston, Texas, USA.ORCID 0000-0002-2752-2365
Shawn Hervey-JumperDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Annette M MolinaroDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.ORCID 0000-0002-9854-7404
Roberta RudàDivision of Neuro-Oncology, Department of Neuroscience, University of Turin, Turin, Italy.
Lorenzo BelloDivision for Neuro-Oncology, Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
Oliver SchnellDepartment of Neurosurgery, University of Freiburg , Freiburg, Germany.
Yoshua EsquenaziDepartment of Neurosurgery, McGovern Medical School at UT Health Houston , Houston, Texas, USA.ORCID 0000-0002-9757-1453
Maximilian I RugeDepartment of Stereotactic and Functional Neurosurgery, Centre for Neurosurgery, University Hospital Cologne , Cologne, Germany.
Stefan J GrauDepartment of Neurosurgery, University of Cologne , Cologne, Germany.
Mitchel S BergerDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.ORCID 0000-0003-1983-4892
Susan M ChangDepartment of Neurosurgery & Division of Neuro-Oncology, University of San Francisco, San Francisco, California,USA.
Martin van den BentDepartment of Neurology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Joerg-Christian TonnDepartment of Neurosurgery, Ludwig-Maximilians-University, Munich, Germany.
University of San Francisco · USThe University of Texas Health Science Center at Houston · USUniversity of Freiburg · DEDeutschen Konsortium für Translationale Krebsforschung · DEUniversity of Cologne · DEUniversity of Milan · ITErasmus MC Cancer Institute · NLLMU Klinikum · DELudwig-Maximilians-Universität München · DEMoffitt Cancer Center · USOspedale Castelfranco Veneto · ITUniversity Hospital Cologne · DEUniversity of Turin · ITUniversity of Zurich · CH

Funding

Training Program in Translational Brain Tumor ResearchT32CA151022 · NCI · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI Joseph F Costello · 2010 to 2026
$6.6M
NCI NIH HHS T32 CA151022
6 · The paper itself

Abstract

backgroundTerminology to describe extent of resection in glioblastoma is inconsistent across clinical trials. A surgical classification system was previously proposed based upon residual contrast-enhancing (CE) tumor. We aimed to (1) explore the prognostic utility of the classification system and (2) define how much removed non-CE tumor translates into a survival benefit.

methodsThe international RANO resect group retrospectively searched previously compiled databases from 7 neuro-oncological centers in the USA and Europe for patients with newly diagnosed glioblastoma per WHO 2021 classification. Clinical and volumetric information from pre- and postoperative MRI were collected.

resultsWe collected 1,008 patients with newly diagnosed IDHwt glioblastoma. 744 IDHwt glioblastomas were treated with radiochemotherapy per EORTC-26981/22981 (TMZ/RT→TMZ) following surgery. Among these homogenously treated patients, lower absolute residual tumor volumes (in cm3) were favorably associated with outcome: patients with "maximal CE resection" (class 2) had superior outcome compared to patients with "submaximal CE resection" (class 3) or "biopsy" (class 4). Extensive resection of non-CE tumor (≤5 cm3 residual non-CE tumor) was associated with better survival among patients with complete CE resection, thus defining class 1 ("supramaximal CE resection"). The prognostic value of the resection classes was retained on multivariate analysis when adjusting for molecular and clinical markers.

conclusionsThe proposed "RANO categories for extent of resection in glioblastoma" are highly prognostic and may serve for stratification within clinical trials. Removal of non-CE tumor beyond the CE tumor borders may translate into additional survival benefit, providing a rationale to explicitly denominate such "supramaximal CE resection."

Indexed as

Brain NeoplasmsGlioblastomaHumansNeurosurgical ProceduresPrognosisRetrospective StudiesTreatment OutcomeclassificationEORglioblastomaoutcomesurgical resection

Identifiers

PMID35961053
PMCPMC10158281
OpenAlexW4290930135

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.