Journal Article

Determinants of survival after re-resection for recurrent glioblastoma: a meta-analysis

Kaur-Paneser, Symriti, Kramer, Andreas, Narendranath, Rithvik M., Namireddy, Srikar R., Thavarajasingam, Ahkash, Salih, Ahmed, Ramsay, Daniele S. C., Kalasauskas, Darius, Stöcklein, Veit, Thavarajasingam, Santhosh G., Ringel, Florian, Jankovic, Dragan, Baby, Manuel V., Scurtu, Daniel, Ponniah, Hariharan Subbiah

2026

Overview

Purpose Glioblastoma (GBM) inevitably recurs despite maximal safe resection and standard chemoradiotherapy. The factors influencing survival after first recurrence and re-resection remain controversial. Research question What are the prognostic factors influencing survival following re-resection of glioblastoma? Methods A systematic search of major databases was conducted for original studies reporting on survival outcomes. Data on hazard ratios (HR) for overall survival and key prognostic factors were extracted, followed by meta-analyses of univariate and multivariate Cox models. Study quality and risk of bias were assessed. Results A total of 30 studies were included. Gross total resection and methylated MGMT promoter status were significantly associated with improved survival, with pooled HRs of 0.52 (95% CI: 0.36–0.76, p  < 0.001) and 0.58 (95% CI: 0.45–0.75, p  < 0.001), respectively. In contrast, age was modestly associated with worse survival (HR: 1.02, 95% CI: 1.01–1.03, p  < 0.001). Preoperative Karnofsky Performance Status (KPS) < 70 was associated with worse survival (HR: 2.25, 95% CI: 1.59–3.19, p  < 0.001). Adjuvant chemotherapy (HR: 0.69, 95% CI: 0.33–1.45, p  = 0.33) and time to re-resection (HR: 0.69, 95% CI: 0.41–1.16, p  = 0.16) failed to show consistent survival benefits. Conclusion Our findings suggest gross total resection of contrast-enhancing tumour and MGMT promoter methylation are strongly associated with improved survival following first recurrence of glioblastoma. Conversely, age, preoperative KPS, adjuvant chemotherapy, and timing of re-resection showed inconsistent or non-significant associations, emphasizing the need for prospective studies to refine prognostic assessments and guide individualized treatment strategies in recurrent glioblastoma. Highlights Re-resection should be considered where gross total re-resection is feasible. Methylated MGMT promoter status indicates effectiveness of alkylating agents in recurrent glioblastoma. More congruence in study design and outcome reporting on KPS and time to re-resection is required to conclude on their prognostic influence.

• Publisher: Springer Vienna,Springer Nature B.V,Springer
• Subject: Adjuvants / Alkylating agents / Bias / Brain cancer / Brain Neoplasms - genetics / Brain Neoplasms - mortality / Brain Neoplasms - surgery / Chemoradiotherapy / Chemotherapy / DNA methylation / Glioblastoma / Glioblastoma - genetics / Glioblastoma - mortality / Glioblastoma - surgery / Glioma / Humans / Interventional Radiology / Medical prognosis / Medicine / Medicine & Public Health / Meta-analysis / Minimally Invasive Surgery / Neoplasm Recurrence, Local - mortality / Neoplasm Recurrence, Local - surgery / Neurology / Neuroradiology / Neurosurgery / Oncology / Patients / Prognosis / Prognostic / Radiation therapy / Re-resection / Recurrence / Reoperation / Review / Sensitivity analysis / Surgical Orthopedics / Survival / Systematic review