What question did this study set out to answer?

The study aimed to assess the prognostic impact of repeat resection at first recurrence in patients with IDH-mutant lower-grade gliomas.

March 14, 2026Open Access

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

Key Points

The study aimed to assess the prognostic impact of repeat resection at first recurrence in patients with IDH-mutant lower-grade gliomas.
Conducted a retrospective analysis involving 148 IDH-mutant glioma patients
Compared outcomes between patients undergoing resection and those receiving non-surgical treatment
Applied volumetric analysis to assess FLAIR tumor volumes
Utilized log-rank tests and Cox regression for identifying prognostic factors
Resection at first recurrence significantly improved progression-free survival (PFS-2) with HR=0.560
Median pre-operative tumor volume was 19.75 cm3, and post-operative was 4.545 cm3
Patients without residual tumor had better PFS-2 compared to those with residual tumor
Functional status was preserved post-operation with stable performance rates at follow-up
Only 2% of patients experienced a permanent deficit after re-resection

Abstract

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. 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. 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. 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.

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