Association between Time to Surgery and Survival in Patients with Initially Diagnosed WHO 2021 Grade 4 Gliomas

Background Glioblastoma (GBM) and other WHO 2021 grade 4 gliomas are highly aggressive tumors treated with maximal safe resection followed by chemoradiation. Although these tumors grow rapidly, the optimal timing of surgery remains unclear. This study evaluated whether time to surgery (TTS), defined as the interval from first admission to surgery, affects prognosis in patients with grade 4 glioma. Methods A total of two hundred nineteen patients with grade 4 glioma were divided into four TTS groups (≤ 3 days, 4–7 days, 8–14 days, ≥ 15 days). Clinical data, including age, sex, tumor location, preoperative and postoperative Karnofsky Performance Status (KPS), KPS at discharge, time from hospitalization to surgery, and extent of resection (EOR), and other various factors were collected from electronic medical records. Results Patients who underwent surgery within 3 days had significantly lower preoperative KPS, whereas longer TTS was associated with higher KPS. Overall survival slightly longer in the group with longer TTS. However, among patients who achieved EOR ≥ 90%, TTS showed no association with survival. Multivariate analysis identified the following independent predictors of better prognosis: higher postoperative KPS, non-GBM histology, achievement of EOR ≥ 90%. TTS itself was not a prognostic factor. Conclusion While urgent surgery is necessary for patients with rapid neurological deterioration, it is important to plan surgery at an appropriate time that allows for preservation of KPS and achievement of maximal safe resection.