{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T22:14:09Z","timestamp":1791238449888,"version":"4.1.0"},"reference-count":23,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T00:00:00Z","timestamp":1749168000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background High-grade gliomas (HGGs) are aggressive brain tumors with poor prognoses. Maximizing the extent of resection (EOR) is a critical surgical goal. Fluorescence-guided surgery using 5-aminolevulinic acid (5-ALA) has been proposed to enhance tumor visualization and resection. MethodsWe retrospectively analyzed 141 patients with histologically confirmed HGGs who underwent either 5-ALA-guided (n = 71) or conventional white-light (n = 70) resection between 2018 and 2023. Propensity score matching and multivariate Cox regression models were used to assess the impact of 5-ALA on surgical outcomes and survival. Results: Gross total resection (GTR) was significantly more common in the 5-ALA group than the conventional white-light group (28.17% vs. 12.86%, p = 0.0245). Kaplan\u2013Meier analysis showed no statistically significant difference in overall survival between groups after matching (log-rank p = 0.6371). However, patients with GTR had significantly improved survival compared to those with subtotal resection (log-rank p = 0.0423). Multivariate Cox regression identified radiotherapy (HR = 0.291, 95% CI: 0.166\u20130.513, p &lt; 0.001), higher Karnofsky Performance Status (HR = 0.962, 95% CI: 0.942\u20130.982, p = 0.0003), and GTR (HR = 0.476, 95% CI: 0.272\u20130.834, p = 0.0091) as independent predictors of improved survival. 5-ALA usage was not an independent predictor (HR = 0.885, 95% CI: 0.554\u20131.413, p = 0.612). Radiotherapy and chemotherapy were more frequently administered in the conventional white-light group (p = 0.0404 and p = 0.0085, respectively). Conclusions 5-ALA fluorescence-guided surgery significantly increases the rate of gross total resection in high-grade glioma patients but does not independently confer a survival advantage. Survival outcomes are primarily influenced by the extent of resection, adjuvant therapy, and functional status. Integration of 5-ALA within a comprehensive oncological framework may enhance its clinical utility.<\/jats:p>","DOI":"10.3390\/cancers17121897","type":"journal-article","created":{"date-parts":[[2025,6,6]],"date-time":"2025-06-06T03:52:28Z","timestamp":1749181948000},"page":"1897","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Comparative Analysis of Clinical Outcomes in High-Grade Glioma Patients: 5-ALA Fluorescence-Guided Surgery vs. Conventional White-Light Resection"],"prefix":"10.3390","volume":"17","author":[{"given":"Nurzhan","family":"Ryskeldiyev","sequence":"first","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidos","family":"Moldabekov","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dinara","family":"Berdibayeva","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3321-9714","authenticated-orcid":false,"given":"Aiman","family":"Maidan","sequence":"additional","affiliation":[{"name":"Taraz City Multidisciplinary Hospital and Consulting and Diagnostic Center, Taraz 080000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Torebek","family":"Tursynbekov","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6100-4963","authenticated-orcid":false,"given":"Dimash","family":"Davletov","sequence":"additional","affiliation":[{"name":"Atchabarov Scientific-Research Institute of Fundamental and Applied Medicine, Asfendiyarov Kazakh National Medical University, Almaty 050000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muratbek","family":"Tleubergenov","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assel","family":"Kabykenova","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Kerimbayeva","sequence":"additional","affiliation":[{"name":"Department of Psychology\/Neuroscience Program, Dickinson College, Carlisle, PA 17013, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aidos","family":"Doskaliyev","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serik","family":"Akshulakov","sequence":"additional","affiliation":[{"name":"National Centre for Neurosurgery, Astana 010000, Kazakhstan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1227\/NEU.0000000000000929","article-title":"What is the Surgical Benefit of Utilizing 5-Aminolevulinic Acid for Fluorescence-Guided Surgery of Malignant Gliomas?","volume":"77","author":"Hadjipanayis","year":"2015","journal-title":"Neurosurgery"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"De Simone, M., Iaconetta, G., Palermo, G., Fiorindi, A., Schaller, K., and De Maria, L. 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