{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T14:36:31Z","timestamp":1787236591447,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin. Pract.","Clinics and Practice"],"abstract":"<jats:p>Background\/Objectives: The independent contribution of extent of resection (EOR) to early recurrence in diffuse gliomas remains debated, as crude analyses are confounded by tumor biology, and real-world data from Eastern European centers are scarce. Methods: We retrospectively studied 283 consecutive adults with surgically treated diffuse gliomas (2021\u20132024) at a Romanian tertiary center. Primary endpoints were recurrence-free survival (RFS) at 1 and 2 years, evaluated as landmark endpoints; secondary endpoints were overall recurrence, reoperation, and reirradiation. Clinical, histopathological, surgical, imaging, and treatment variables were analyzed with complete-case Firth-penalized logistic regression. Results: Among evaluable patients, 70.6% (132\/187) were recurrence-free at 1 year and 64.2% (120\/187) at 2 years; overall recurrence occurred in 53.7% (139\/259). After adjustment, gross total resection (GTR) was independently associated with higher odds of remaining recurrence-free at 1 year (OR 12.37, 95% CI 3.23\u201352.58; p &lt; 0.001) and 2 years (OR 10.56; p &lt; 0.001), as was subtotal resection (STR) at both time points (OR 4.15, 95% CI 1.17\u201316.16, p = 0.027; and OR 3.93, p = 0.027), versus partial resection\/biopsy. Conclusions: EOR was independently associated with early RFS, supporting maximal safe resection as a primary surgical objective. The landmark endpoints were not evaluable in 96 of 283 patients, almost all of whom underwent biopsy or partial resection, so the odds ratios indicate the direction of the effect and not its precise magnitude. Overall recurrence, evaluable in 91.5% of the cohort, showed a concordant gradient. External validation is needed.<\/jats:p>","DOI":"10.3390\/clinpract16080155","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T12:57:53Z","timestamp":1787230673000},"page":"155","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Gross Total Resection and Recurrence-Free Survival in Diffuse Gliomas: A Single-Center Cohort Study from Eastern Europe"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6776-4709","authenticated-orcid":false,"given":"Teodor Cristian","family":"Blidaru","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4787-3172","authenticated-orcid":false,"given":"Marius Cristian","family":"Zaharia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Mitrea","sequence":"additional","affiliation":[{"name":"Neuroaxis Neurology Clinic, 040215 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca Maria","family":"Marin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6977-1740","authenticated-orcid":false,"given":"Natalia","family":"Blidaru","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Ghica","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Sinziana","family":"Matei","sequence":"additional","affiliation":[{"name":"Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raluca","family":"Papacocea","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6112-0223","authenticated-orcid":false,"given":"Stefan","family":"Strilciuc","sequence":"additional","affiliation":[{"name":"Department of Genomics, Medfuture Institute for Biomedical Research, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dragos Nicolae","family":"Garofil","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1231","DOI":"10.1093\/neuonc\/noab106","article-title":"The 2021 WHO Classification of Tumors of the Central Nervous System: A summary","volume":"23","author":"Louis","year":"2021","journal-title":"Neuro-Oncology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1038\/s41571-020-00447-z","article-title":"EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood","volume":"18","author":"Weller","year":"2021","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e404","DOI":"10.1016\/S1470-2045(24)00130-X","article-title":"The oncological role of resection in newly diagnosed diffuse adult-type glioma defined by the WHO 2021 classification: A Review by the RANO resect group","volume":"25","author":"Karschnia","year":"2024","journal-title":"Lancet Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1001\/jamaoncol.2019.6143","article-title":"Association of Maximal Extent of Resection of Contrast-Enhanced and Non-Contrast-Enhanced Tumor with Survival Within Molecular Subgroups of Patients with Newly Diagnosed Glioblastoma","volume":"6","author":"Molinaro","year":"2020","journal-title":"JAMA Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.ejca.2021.03.002","article-title":"Evidence-based recommendations on categories for extent of resection in diffuse glioma","volume":"149","author":"Karschnia","year":"2021","journal-title":"Eur. J. Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5187","DOI":"10.1200\/JCO.23.01059","article-title":"RANO 2.0: Update to the Response Assessment in Neuro-Oncology Criteria for High- and Low-Grade Gliomas in Adults","volume":"41","author":"Wen","year":"2023","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1846","DOI":"10.3174\/ajnr.A8396","article-title":"A Neuroradiologist\u2019s Guide to Operationalizing the Response Assessment in Neuro-Oncology (RANO) Criteria Version 2.0 for Gliomas in Adults","volume":"45","author":"Ellingson","year":"2024","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Incekara, F., Smits, M., van der Voort, S.R., Dubbink, H.J., Atmodimedjo, P.N., Kros, J.M., Vincent, A.J.P.E., and Bent, M.v.D. (2020). The Association Between the Extent of Glioblastoma Resection and Survival in Light of MGMT Promoter Methylation in 326 Patients with Newly Diagnosed IDH-Wildtype Glioblastoma. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.01087"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1038\/s41598-020-59089-x","article-title":"Extent of resection and molecular pathologic subtype are potent prognostic factors of adult WHO grade II glioma","volume":"10","author":"Choi","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1371","DOI":"10.1007\/s10143-020-01362-8","article-title":"Extent of resection in diffuse low-grade gliomas and the role of tumor molecular signature-a systematic review of the literature","volume":"44","author":"Albuquerque","year":"2021","journal-title":"Neurosurg. Rev."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Penkova, A., Kuziakova, O., Gulaia, V., Tiasto, V., Goncharov, N.V., Lanskikh, D., Zhmenia, V., Baklanov, I., Farniev, V., and Kumeiko, V. (2023). Comprehensive clinical assays for molecular diagnostics of gliomas: The current state and future prospects. Front. Mol. Biosci., 10.","DOI":"10.3389\/fmolb.2023.1216102"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1159\/000528487","article-title":"Perspectives for Cancer Care and Research in Central and Eastern Europe","volume":"46","author":"Zielinski","year":"2023","journal-title":"Oncol. Res. Treat."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100438","DOI":"10.1016\/j.jcpo.2023.100438","article-title":"European Cancer Organisation Essential Requirements for Quality Cancer Care: Adult glioma","volume":"38","author":"Bozzao","year":"2023","journal-title":"J. Cancer Policy"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"World Medical Association (2013). World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA, 310, 2191\u20132194.","DOI":"10.1001\/jama.2013.281053"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1177\/1742395312466903","article-title":"\u201cJust give me the best quality of life questionnaire\u201d: The Karnofsky scale and the history of quality of life measurements in cancer trials","volume":"9","author":"Timmermann","year":"2013","journal-title":"Chronic Illn."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"vdad126","DOI":"10.1093\/noajnl\/vdad126","article-title":"Impact of extent of resection on outcome from glioblastoma using the RANO resect group classification system: A retrospective, population-based cohort study","volume":"5","author":"Bjorland","year":"2023","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_18","unstructured":"R Core Team (2025). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1093\/neuonc\/noac193","article-title":"Prognostic validation of a new classification system for extent of resection in glioblastoma: A report of the RANO resect group","volume":"25","author":"Karschnia","year":"2023","journal-title":"Neuro-Oncology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"717","DOI":"10.1007\/s11060-022-04192-4","article-title":"Association of extent of resection and functional outcomes in diffuse low-grade glioma: Systematic review & meta-analysis","volume":"160","author":"Elsheikh","year":"2022","journal-title":"J. Neurooncol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1227\/neu.0000000000002964","article-title":"Extent of Resection Thresholds in Molecular Subgroups of Newly Diagnosed Isocitrate Dehydrogenase-Wildtype Glioblastoma","volume":"95","author":"Dono","year":"2024","journal-title":"Neurosurgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.3171\/2020.2.JNS192767","article-title":"Extent of resection, molecular signature, and survival in 1p19q-codeleted gliomas","volume":"134","author":"Garton","year":"2021","journal-title":"J. Neurosurg."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Skardelly, M., Kaltenstadler, M., Behling, F., M\u00e4urer, I., Schittenhelm, J., Bender, B., Paulsen, F., Hedderich, J., Renovanz, M., and Gempt, J. (2021). A Continuous Correlation Between Residual Tumor Volume and Survival Recommends Maximal Safe Resection in Glioblastoma Patients: A Nomogram for Clinical Decision Making and Reference for Non-Randomized Trials. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.748691"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1437","DOI":"10.3390\/curroncol28020136","article-title":"On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI","volume":"28","author":"Kasper","year":"2021","journal-title":"Curr. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"vdac115","DOI":"10.1093\/noajnl\/vdac115","article-title":"Reoperation in adult patients with recurrent glioblastoma: A matched cohort analysis","volume":"4","author":"Yang","year":"2022","journal-title":"Neuro-Oncol. Adv."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s11060-024-04595-5","article-title":"Repeat surgery of recurrent glioma for molecularly informed treatment in the age of precision oncology: A risk-benefit analysis","volume":"167","author":"Alhalabi","year":"2024","journal-title":"J. Neurooncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.radonc.2021.12.019","article-title":"Re-irradiation for recurrent high grade glioma (HGG) patients: Results of a single arm prospective phase 2 study","volume":"167","author":"Navarria","year":"2022","journal-title":"Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e619","DOI":"10.1016\/j.wneu.2022.05.039","article-title":"A Nomogram for Predicting Early Recurrence in Patients with High-Grade Gliomas","volume":"164","author":"Zhou","year":"2022","journal-title":"World Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wang, T., Zhu, C., Zheng, S., Liao, Z., Chen, B., Liao, K., Yang, X., Zhou, Z., Bai, Y., and Wang, Z. (2021). A Novel Nomogram for Predicting the Risk of Short-Term Recurrence After Surgery in Glioma Patients. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.740413"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1007\/s00432-024-06008-6","article-title":"Prognostic nomogram model based on quantitative metrics of subregions surrounding residual cavity in glioblastoma patients","volume":"150","author":"Gao","year":"2024","journal-title":"J. Cancer Res. Clin. Oncol."}],"container-title":["Clinics and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/8\/155\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T13:38:44Z","timestamp":1787233124000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-7283\/16\/8\/155"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["clinpract16080155"],"URL":"https:\/\/doi.org\/10.3390\/clinpract16080155","relation":{},"ISSN":["2039-7283"],"issn-type":[{"value":"2039-7283","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}