232 Onco-functional Outcome After Resection for Eloquent Glioblastoma (GLIOFO): A Propensity-score Matched Analysis of an International, Multicenter, Cohort Study

INTRODUCTION: Minimizing residual tumor volume and preventing functional loss are the primary goal in glioblastoma resections in eloquent areas. However, their combined impact on patient outcomes remains poorly understood. METHODS: Propensity-score matching was used to match OFO 1 (gross-total resection with no functional loss), OFO 2 (no gross-total resection with no functional loss), OFO 3 (gross-total resection with functional loss) and OFO 4 patients (no gross-total resection with functional loss) for the overall cohort and subgroups. Cox proportional-hazard regressions were performed to analyze the association between OFO class and surgical outcomes. Logistic regressions were performed to identify preoperative predictors for OFO class. RESULTS: Between 2010 and 2020, 858 patients were included as the overall unmatched cohort. After matching, the cohort comprised of 512 patients: 256 received OFO 1 and 256 received non-OFO 1. OFO 1 resulted in fewer postoperative neurological deficits at 6 weeks (10.2% vs. 25.8%, p < 0.001), 3 months (12.7% vs. 9.9%, p < 0.001), and 6 months (21.0% vs. 35.1%, p = 0.0010); lower rates of KPS deterioration at 3 months (14.2% vs. 52.4%, p < 0.001), and 6 months (26.5% vs. 52.9%, p < 0.001); higher rate of receipt of adjuvant therapy (HR 3.91, p < 0.001), longer overall survival (median 21.0 vs. 13.0 months, p < 0.001), and longer progression-free survival (median 10.0 vs. 7.5 months, p < 0.001). Patients who underwent awake craniotomy more often received OFO 1 (43.0% vs. 26.9%, p < 0.001; OR 1.92, p = 0.0070). CONCLUSIONS: OFO 1 is beneficial in patients with eloquent glioblastoma to improve outcomes - irrespective of age, preoperative NIHSS, or KPS - in terms of survival, functional outcomes, and receipt of adjuvant therapy. Awake craniotomy was significantly associated with achieving this.