Journal of Neuro-Oncology

, Volume 137, Issue 2, pp 367–377 | Cite as

Is a pretreatment radiological staging system feasible for suggesting the optimal extent of resection and predicting prognosis in glioblastoma? An observational study

  • Jaume Capellades
  • Josep Puig
  • Sira Domenech
  • Teresa Pujol
  • Laura Oleaga
  • Angels Camins
  • Carles Majós
  • Rocio Diaz
  • Christian de Quintana
  • Pilar Teixidor
  • Gerard Conesa
  • Gerard Plans
  • Josep Gonzalez
  • Natalia García-Balañà
  • Jose Maria Velarde
  • Carmen BalañaEmail author
Clinical Study


To assess the value of resection in glioblastoma based on pre-surgical tumor characteristics and a subsequent staging system. The lack of a staging system for glioblastoma hinders the analysis of treatment outcome. We classified 292 uniformly treated glioblastoma patients as stage I, II, or III based on tumor size, location, and eloquence and then analyzed the impact of the extent of resection. We classified 62% of patients as stage I, 25.3% as stage II, and 12.7% as stage III. Gross total resection (GTR) was performed mainly in stage I rather than stage II or III patients (79.2% vs. 14.6% vs. 6.3%; P < 0.001). Overall survival (OS) was 17.7, 14.6, and 10.8 months for stage I, II, and III patients, respectively (P = 0.005). Longer OS was significantly associated with greater extent of resection, younger age, KPS ≥ 70%, MGMT methylation, lower stage, and tumor ≤ 5 cm. In the subgroups of stage I (P = 0.04) and stage II (P < 0.001)—but not stage III—patients, GTR and partial resection (PR) were associated with longer OS. We constructed several multivariable models including different variables, and greater extent of resection, smaller tumor size, and MGMT methylation consistently emerged as independent markers of longer OS. This staging system provides a feasible tool for comparison of results. We confirmed the value of partial resection in stage I and II patients, in contrast to some reports suggesting that biopsy only is sufficient when gross total resection cannot be safely achieved.


Glioblastoma Staging Extent of resection Imaging MGMT Prognosis 



This work was supported by Fundació La Marató TV3 (665/C/2013) ( The radiological platform is supported by the citizens’ initiative “Associacio Montgat en Acció”: G66504572.

Compliance with ethical standards

Conflict of interest

Carmen Balaña declares an advisory position for AbbVie and financial support for attending symposia of Pharmamar. The rest of authors declare they don’t have any conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Jaume Capellades
    • 1
  • Josep Puig
    • 2
  • Sira Domenech
    • 3
  • Teresa Pujol
    • 4
  • Laura Oleaga
    • 4
  • Angels Camins
    • 5
  • Carles Majós
    • 5
  • Rocio Diaz
    • 3
  • Christian de Quintana
    • 6
  • Pilar Teixidor
    • 7
  • Gerard Conesa
    • 8
  • Gerard Plans
    • 9
  • Josep Gonzalez
    • 10
  • Natalia García-Balañà
    • 11
  • Jose Maria Velarde
    • 11
  • Carmen Balaña
    • 12
    Email author return OK on get
  1. 1.Radiology Hospital del MarBarcelonaSpain
  2. 2.Imaging Research Unit, Institut Diagnòstic per la Imatge (IDI), Biomedical Research Institute (IDIBGI)Hospital Universitari Dr Josep TruetaGironaSpain
  3. 3.RadiologyInstitut Diagnòstic per la Imatge (IDI)BadalonaSpain
  4. 4.Radiology DepartmentHospital ClinicBarcelonaSpain
  5. 5.RadiologyInstitut Diagnòstic per la Imatge (IDI)L’Hospitalet de LLobregatSpain
  6. 6.Neurosurgery DepartmentHospital de la Santa Creu i de Sant PauBarcelonaSpain
  7. 7.Neurosurgery DepartmentHospital Germans Trias I PujolBadalonaSpain
  8. 8.Neurosurgery DepartmentHospital del MarBarcelonaSpain
  9. 9.Neurosurgery DepartmentHospital de BellvitgeL’Hospitalet de LLobregatSpain
  10. 10.Neurosurgery DepartmentHospital ClinicBarcelonaSpain
  11. 11.Institut Investigació Germans Trias i Pujol (IGTP)BadalonaSpain
  12. 12.Medical Oncology Service, Institut Català d’Oncologia (ICO)Hospital Germans Trias i PujolBarcelonaSpain

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