Comparative Analysis of Clinical Outcomes in High-Grade Glioma Patients: 5-ALA Fluorescence-Guided Surgery vs. Conventional White-Light Resection

Ryskeldiyev N. Moldabekov A. Berdibayeva D. Maidan A. Tursynbekov T. Davletov D. Tleubergenov M. Kabykenova A. Kerimbayeva D. Doskaliyev A. Akshulakov S.
June 2025 Multidisciplinary Digital Publishing Institute (MDPI)

Cancers
2025 #17 Issue 12

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–Meier 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: 0.166–0.513, p < 0.001), higher Karnofsky Performance Status (HR = 0.962, 95% CI: 0.942–0.982, p = 0.0003), and GTR (HR = 0.476, 95% CI: 0.272–0.834, p = 0.0091) as independent predictors of improved survival. 5-ALA usage was not an independent predictor (HR = 0.885, 95% CI: 0.554–1.413, 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.

5-aminolevulinic acid , extent of resection (EOR) , fluorescence-guided surgery , glioblastoma , neuro-oncology

Text of the article Перейти на текст статьи

National Centre for Neurosurgery, Astana, 010000, Kazakhstan
Taraz City Multidisciplinary Hospital and Consulting and Diagnostic Center, Taraz, 080000, Kazakhstan
Atchabarov Scientific-Research Institute of Fundamental and Applied Medicine, Asfendiyarov Kazakh National Medical University, Almaty, 050000, Kazakhstan
Department of Psychology/Neuroscience Program, Dickinson College, Carlisle, 17013, PA, United States

National Centre for Neurosurgery
Taraz City Multidisciplinary Hospital and Consulting and Diagnostic Center
Atchabarov Scientific-Research Institute of Fundamental and Applied Medicine
Department of Psychology/Neuroscience Program

10 лет помогаем публиковать статьи Международный издатель

Книга Публикация научной статьи Волощук 2026 Book Publication of a scientific article 2026