What question did this study set out to answer?

This study aims to assess the prognostic value of early postoperative FLAIR lesion volume reduction in glioblastoma patients undergoing gross total resection.

May 15, 2026Open Access

Prediction of Overall Survival in Glioblastoma Using Early Postoperative Reduction in FLAIR Lesion Volume After Gross Total Resection

Key Points

This study aims to assess the prognostic value of early postoperative FLAIR lesion volume reduction in glioblastoma patients undergoing gross total resection.
Retrospective cohort study of 51 adults with newly diagnosed glioblastoma, IDH-wildtype, and gross total resection.
FLAIR lesion volume measured preoperatively, immediately postoperatively, at 1 month, and at 3 months using semi-automated techniques.
Multivariable Cox models for overall survival were fitted, adjusted for age, MGMT methylation, and postoperative Karnofsky Performance Status.
Each 10-percentage-point early FLAIR lesion volume reduction was associated with a lower mortality risk (HR 0.91, 95% CI 0.82–0.99, p = 0.037).
A late FLAIR lesion volume reduction showed a smaller effect on overall survival (HR 0.99, 95% CI 0.98–1.00, p = 0.043).
Early responders (≥ 20% reduction) had significantly better overall survival (HR 0.33, p = 0.010).

Abstract

Background/Objectives: Glioblastoma (GBM) comprises a contrast-enhancing (CE) mass and peritumoral hyperintensity on fluid-attenuated inversion recovery (FLAIR) on magnetic resonance imaging (MRI). Although a smaller residual FLAIR lesion volume (FLV) after gross total resection (GTR) is associated with longer survival, the clinical observation of rapid FLV reduction within the first postoperative month remains unknown. We evaluated the independent prognostic contributions of early and late FLV reduction in patients with newly diagnosed GBM, isocitrate dehydrogenase (IDH)-wildtype, who underwent GTR. Methods: In a retrospective cohort of 51 adults with GBM, IDH-wildtype, who underwent GTR and standard chemoradiotherapy, semi-automated FLV was measured on MRI preoperatively, immediately postoperatively (FLV0), at 1 month (FLV1), and at 3 months (FLV3). FLV changes were expressed as percentage changes relative to the preceding timepoint (ΔFLV0-1, ΔFLV1-3). Using a 3-month landmark analysis, multivariable Cox models for overall survival (OS) were fitted, adjusted for age, O6-methylguanine-DNA-methyltransferase promoter (pMGMT) methylation, and postoperative Karnofsky Performance Status (KPS). Results: In the multivariable 3-month landmark analysis, each 10-percentage-point early FLV reduction (∆FLV0-110-pp) was associated with lower mortality risk (hazard ratio HR 0.91, 95% confidence interval CI 0.82–0.99, p = 0.037) whereas a late FLV reduction (∆FLV1-310-pp) showed a smaller association with OS (HR 0.99, 95% CI 0.98–1.00, p = 0.043). In an exploratory dichotomized analysis at a 20% reduction threshold, early responders (∆FLV0-1 ≥ 20%) had markedly better OS (HR 0.33, p = 0.010). Conclusions: In selected patients with GBM, IDH-wildtype, who achieved radiographic GTR and received standard chemoradiotherapy, early postoperative FLV reduction at 1 month independently predicted longer OS, with a substantially larger effect than late reduction. Prospective multi-center validation is required before clinical implementation.

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Cite This Study

Aoki et al. (Wed,) studied this question.

synapsesocial.com/papers/6a06b83de7dec685947aad02 https://doi.org/https://doi.org/10.3390/cancers18101585

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