Evaluating the role of gross total resection in primary spinal cord glioblastoma: evidence from a multicenter cohort and meta-analysis

Background: Primary spinal cord glioblastoma (PscGB) is a rare, aggressive tumor that accounts for about 7.5% of spinal cord gliomas. Its infiltrative growth and proximity to critical neural structures make diagnosis and management challenging, and data on prognostic factors and optimal treatment remain limited. Objective: To evaluate the impact of the extent of surgical resection and adjuvant chemoradiotherapy on overall survival (OS) in PscGB, and to identify independent predictors of poor prognosis. Methods: A retrospective multicenter cohort was analyzed alongside a systematic review and meta-analysis of comparative clinical studies. Through stringent enrollment criteria, demographic, clinical, radiological, and surgical data were collected. The overall survival (OS) was the primary outcome. Survival outcomes were evaluated with Kaplan-Meier curves, while predictors of better OS were identified using univariate and multivariate least squares regression. For the meta-analysis, individual patient data were retrieved where available, and a random-effects model using hazard ratios (HR) assessed the effects of extent of resection and adjuvant therapy on survival. Results: The multicenter cohort (n = 13) and systematic review (n = 67) together included 80 operated PscGB patients. The meta-analysis combined data from five published comparative studies plus our institutional series, for a total of 111 patients. No significant difference in OS was observed among patients undergoing gross total resection, subtotal resection, or biopsy (HR = 0.68, 95% CI: 0.29-1.58; p = 0.37). In contrast, adjuvant chemoradiotherapy was significantly associated with improved survival (HR = 0.37, 95% CI: 0.17-0.78; p = 0.009). Multivariate analysis identified delayed surgery (p < 0.01) and absence of adjuvant chemoradiotherapy (p < 0.01) as independent predictors of poorer OS. Sensitivity and publication bias analyses supported the robustness of these findings. Conclusion: In this study, gross total resection did not provide a significant survival benefit in PscGB, while earlier surgery and adjuvant chemoradiotherapy were associated with improved outcomes. However, our findings are to be interpreted as merely observational and not conclusive and therefore should be observed with caution. Larger prospective studies are needed to confirm these results and inform clinical practice.