Value-based assessment of repeat surgery for recurrent glioma: a real-world quality-adjusted survival analysis

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ID: 329085
2026
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Ranked #121 of 144 articles by views in Neuro-Oncology Advances

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Abstract
Abstract Background Reoperation for recurrent glioma is widely practiced, yet clinical decision-making remains challenging due to substantial trade-offs between survival gain and postoperative functional burden. High-quality real-world evidence integrating survival and quality-of-life outcomes to inform reoperation decisions remains limited. Methods We conducted a retrospective real-world cohort study of 1,304 adult patients with recurrent glioma treated between 2010 and 2018. Propensity score matching was applied to balance baseline characteristics. Survival outcomes, quality-adjusted life years (QALYs), functional status, and prognostic factors associated with reoperation benefit were evaluated. Results In the 1:1 propensity-matched cohort (140 reoperation vs 140 non-reoperation), reoperation was associated with a mean gain of 9.6 months in quality-adjusted life years (QALYs) and a 521-day longer overall survival. Postoperative functional status showed short-term improvement. In the glioblastoma subgroup, reoperation was associated with a numerical gain of 3.5 QALY months, although the confidence interval crossed zero, alongside a 218-day gain in overall survival. Predictive models based on preoperative characteristics demonstrated good discrimination in identifying patients likely to derive survival benefit beyond six months. Conclusions This study provides real-world evidence that carefully selected patients with recurrent glioma may derive quality-adjusted survival benefits from reoperation, thereby supporting individualized surgical decision-making. These findings have implications for value-based surgical decision-making in recurrent glioma, particularly in healthcare systems where balancing survival benefit against functional outcomes and resource use is increasingly important.
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Authors Wanyu Qiao, Chen Luo, Tian Gan, Shuai Wu, Xian Xie, Jinsong Wu, Hugues Duffau, Jie Zhang, Ye Yao
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Journal Neuro-Oncology Advances
Year 2026
DOI
10.1093/noajnl/vdag251
URL
https://doi.org/10.1093/noajnl/vdag251
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