Metabolic boundary resection of glioblastoma correlates with clinical outcome and survival analysis: a comparative cohort study.
OBJECTIVE The objective of this study was to investigate the impact of 3D 1H-MR spectroscopy (MRS)-guided metabolic boundary resection (MBR) on the extent of resection (EOR), surgical safety, and prognosis in glioblastoma. METHODS A retrospective analysis was performed on clinical data from patients with IDH-wildtype glioblastoma who underwent resection at the authors' hospital. Patients were divided into two groups based on surgical methods: the traditional boundary resection (TBR) group (neuronavigation + contrast-enhancing [CE] boundary resection) and the MBR group (3D 1H-MRS combined with neuronavigation + MBR). Demographic, perioperative, and follow-up data were collected and compared between the two groups. Cox proportional hazards regression and Kaplan-Meier survival analysis were used to evaluate the effects of various clinical and treatment-related factors on patient survival. RESULTS The MBR group included 41 patients (mean age 54.17 ± 12.04 years, 65.85% male) with a mean tumor volume of 58.07 ± 20.63 cm3. The TBR group included 30 patients (mean age 56.86 ± 9.78 years, 63.33% male) with a mean tumor volume of 52.51 ± 24.06 cm3. There were no statistically significant differences between the two groups in tumor laterality, location, volume, and length of hospital stay. In the TBR group, 10 patients achieved supra-total resection (SpTR), 13 achieved gross-total resection (GTR), and 7 achieved subtotal resection (STR). In the MBR group, 25 patients achieved SpTR, 10 achieved GTR, and 6 achieved STR. The rate of SpTR was significantly higher in the MBR group compared to the TBR group (p = 0.021). Postoperative neurological deficits occurred in 1 patient (2.4%) in the MBR group (transient) and 2 patients (6.7%) in the TBR group (1 permanent). No significant difference in complication rates was observed (p = 0.369). Kaplan-Meier survival analysis and log-rank tests demonstrated that the MBR group had significantly longer progression-free survival (PFS) and overall survival (OS) compared to the TBR group (p < 0.001). Multivariable Cox proportional hazards regression analysis identified EOR and surgical methods as independent prognostic factors. CONCLUSIONS Three-dimensional 1H-MRS combined with a neuronavigation system is used to guide glioblastoma resection along the metabolic boundary during surgery, which can lead to a more complete resection of the glioblastoma and improve the PFS and OS of patients. Compared to CE boundary resection, MBR appears to be a stronger prognostic factor for survival.