据分子时代的成人型弥漫性胶质瘤类型不同，增强效果（CE）和非增强效果（NE）瘤的切除程度（Extent of resection，EOR）可能对生存率产生不同的影响。本研究旨在根据2021年世界卫生组织（World Health Organization）分类评估CE和NE瘤的EOR对胶质瘤的影响。本回顾性研究纳入了从2001年至2021年诊断的1193例成人型弥漫性胶质瘤患者（其中包括183例少突胶质瘤、211例异柠檬酸脱氢酶[IDH]突变星形细胞瘤和799例IDH野生型胶质母细胞瘤患者）来自一家单一机构。患者具有关于IDH突变、1p/19q 缺失和O6-甲基鸟嘌呤-甲基转移酶（MGMT）状态的完整信息。分别在每种胶质瘤类型中进行Cox生存分析，以评估EOR的CE和NE瘤、临床、影像学数据、组织学分级、MGMT状态、辅助治疗以及临床完整切除（Gross total resection，GTR）等对总生存率的预测因素。在CE瘤的患者中进行亚组分析。在1193例患者中，有935例（78.4%）患者有CE瘤。在整个少突胶质瘤中，NE瘤的完整切除与生存率无关（HR = 0.56，p = 0.223）。在CE瘤的86例（47.0%）少突胶质瘤患者中，CE瘤的完整切除是唯一的独立生存预测因素（HR = 0.16，p = 0.004）经多变量分析。GTR的CE和NE瘤与IDH突变星形细胞瘤和IDH野生型胶质母细胞瘤的生存率改善相关（所有p < 0.05）。GTR的CE和NE瘤可能显著提高IDH突变星形细胞瘤和IDH野生型胶质母细胞瘤的生存率。在少突胶质瘤中，CE瘤的EOR可能是生存的关键；过于积极地切除NE瘤可能是不必要的，而建议进行CE瘤的积极切除。根据2021年世界卫生组织分类的成人型弥漫性胶质瘤，应重新评估对CE瘤和NE瘤的外科策略，考虑到在完整切除（GTR）后CE和NE瘤的不同生存结局。对成人型弥漫性胶质瘤进行了增强效果（CE）和非增强效果（NE）瘤的切除程度对生存率的评估。在异柠檬酸脱氢酶（IDH）突变星形细胞瘤和IDH野生型胶质母细胞瘤中，完整切除CE和NE瘤可能改善生存率，而只有完整切除CE瘤能够改善少突胶质瘤的生存率。根据成人型弥漫性胶质瘤的类型，外科策略应重新考虑。© 2023. The Author(s), under exclusive licence to European Society of Radiology.

Extent of resection (EOR) of contrast-enhancing (CE) and non-enhancing (NE) tumors may have different impacts on survival according to types of adult-type diffuse gliomas in the molecular era. This study aimed to evaluate the impact of EOR of CE and NE tumors in glioma according to the 2021 World Health Organization classification.This retrospective study included 1193 adult-type diffuse glioma patients diagnosed between 2001 and 2021 (183 oligodendroglioma, 211 isocitrate dehydrogenase [IDH]-mutant astrocytoma, and 799 IDH-wildtype glioblastoma patients) from a single institution. Patients had complete information on IDH mutation, 1p/19q codeletion, and O6-methylguanine-methyltransferase (MGMT) status. Cox survival analyses were performed within each glioma type to assess predictors of overall survival, including clinical, imaging data, histological grade, MGMT status, adjuvant treatment, and EOR of CE and NE tumors. Subgroup analyses were performed in patients with CE tumor.Among 1193 patients, 935 (78.4%) patients had CE tumors. In entire oligodendrogliomas, gross total resection (GTR) of NE tumor was not associated with survival (HR = 0.56, p = 0.223). In 86 (47.0%) oligodendroglioma patients with CE tumor, GTR of CE tumor was the only independent predictor of survival (HR = 0.16, p = 0.004) in multivariable analysis. GTR of CE and NE tumors was independently associated with better survival in IDH-mutant astrocytoma and IDH-wildtype glioblastoma (all ps < 0.05).GTR of both CE and NE tumors may significantly improve survival within IDH-mutant astrocytomas and IDH-wildtype glioblastomas. In oligodendrogliomas, the EOR of CE tumor may be crucial in survival; aggressive GTR of NE tumor may be unnecessary, whereas GTR of the CE tumor is recommended.Surgical strategies on contrast-enhancing (CE) and non-enhancing (NE) tumors should be reassessed considering the different survival outcomes after gross total resection depending on CE and NE tumors in the 2021 World Health Organization classification of adult-type diffuse gliomas.The survival impact of extent of resection of contrast-enhancing (CE) and non-enhancing (NE) tumors was evaluated in adult-type diffuse gliomas. Gross total resection of both CE and NE tumors may improve survival in isocitrate dehydrogenase (IDH)-mutant astrocytomas and IDH-wildtype glioblastomas, while only gross total resection of the CE tumor improves survival in oligodendrogliomas. Surgical strategies should be reconsidered according to types in adult-type diffuse gliomas.© 2023. The Author(s), under exclusive licence to European Society of Radiology.