Tumor-like alterations in brain tissue adjacent to glioblastoma: an integrated analysis based on continuous en bloc resection strategy.

The prognosis for glioblastoma (GBM) is correlated with the extent of resection. Continuous en bloc resection (CEBR) is a surgical strategy that involves the removal of the gross tumor along with its normal adjacent tissue (NAT) as "one whole block". However, its impact on the survival of patients with GBM in non-eloquent areas is unknown. We found that CEBR significantly prolongs both overall survival and progression-free survival in patients with GBM in non-eloquent areas. We further reported that the molecular drivers, transcriptomic abnormalities, and microenvironmental alterations akin to those found in tumors were detected in the NAT. These tumor-like molecular and microenvironmental alterations were predominantly present in the NAT within 10 mm around the tumor, despite the absence of identifiable tumor cells on rigorous histological examination. Overall, CEBR improved survival in patients with GBM in non-eloquent areas, while tumor-like alterations were present in brain tissue adjacent to the tumor. These findings provide the rationale to incorporate NAT into the extent of resection in the CEBR strategy and support further investigation of the association between its resection and patient prognosis.