Value-based assessment of repeat surgery for recurrent glioma: A real-world quality-adjusted survival analysis
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 1304 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 6 months. Conclusion: 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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BibTeX
@article{qiao2026valuebased,
title = {{Value-based assessment of repeat surgery for recurrent glioma: A real-world quality-adjusted survival analysis}},
author = {Wanyu Qiao and Chen Luo and Tian Gan and Shuai Wu and Xian Xie and Jinsong Wu and Hugues Duffau and Jie Zhang and Ye Yao},
journal = {Neuro-Oncology Advances},
year = {2026},
month = sep,
doi = {10.1093/noajnl/vdag251},
url = {https://hal.science/hal-05803587v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Value-based assessment of repeat surgery for recurrent glioma: A real-world quality-adjusted survival analysis
AU - Wanyu Qiao
AU - Chen Luo
AU - Tian Gan
AU - Shuai Wu
AU - Xian Xie
AU - Jinsong Wu
AU - Hugues Duffau
AU - Jie Zhang
AU - Ye Yao
PY - 2026
DA - 2026/09/18
JO - Neuro-Oncology Advances
DO - 10.1093/noajnl/vdag251
UR - https://hal.science/hal-05803587v1
AB - 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 1304 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 6 months. Conclusion: 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.
SN - 2632-2498
ER -