Abstract / Summary
Abstract Purpose Butterfly glioblastoma (bGBM) presents major neurosurgical challenges. We investigated prognostic factors and the role of surgical resection in bGBM. Methods We retrospectively reviewed 23 consecutive patients with bGBM treated between 2007 and 2025. Overall survival (OS), progression-free survival (PFS), and postoperative deterioration in Karnofsky Performance Status (KPS), assessed immediately after surgery and at 2 weeks, were analyzed using Cox and logistic regression models. Results Biopsy and surgical resection were performed in 9 and 14 patients, respectively. Radiotherapy plus temozolomide was administered to 22 patients. Median OS and PFS were 10.0 and 4.4 months. On univariable Cox analysis, age (hazard ratio [HR], 1.04; p = 0.015), immediate postoperative KPS (HR, 0.96; p = 0.004), and KPS at 2 weeks (HR, 0.96; p = 0.002) were associated with OS; however, only KPS at 2 weeks remained an independent prognostic factor on multivariable analysis. Similar variables were associated with PFS, with age remaining an independent predictor (HR, 1.06; p = 0.018). Kaplan-Meier analysis showed no significant difference in PFS by extent of resection (EOR; ≥ 85% vs. < 85%) using the log-rank test ( p = 0.214), whereas the Wilcoxon test was significant ( p = 0.036), suggesting improved early disease control with EOR ≥ 85%. In the multivariable logistic regression, surgical complications independently predicted KPS deterioration at 2 weeks (odds ratio, 16.7; p = 0.017). Conclusion In bGBM, surgical resection may be beneficial only when it preserves postoperative functional status and avoids complications. When safely achievable, EOR ≥ 85% may contribute to early disease control.