新诊断的胶质母细胞瘤对于强化对比剂（CE）的肿瘤切除代表了标准护理。然而，有些最终被诊断为胶质母细胞瘤的肿瘤缺乏对比剂增强，且在成像上呈现出“低等级外观”（非CE胶质母细胞瘤）。我们的目标是（I）以容积的方式定义无对比剂增强的肿瘤切除的价值，并（II）勾勒出胶质母细胞瘤患者中有对比剂增强和无对比剂增强的预后差异。 RANO切除组回顾性地收集了一个全球的、八个中心的、根据WHO 2021分类的新诊断胶质母细胞瘤患者队列。分析了术后肿瘤体积与预后之间的关联。构建了倾向评分匹配分析，比较了具有对比剂增强和无对比剂增强的胶质母细胞瘤。 在1323例新诊断的IDH野生型胶质母细胞瘤中，我们鉴定出98例（7.4%）无对比剂增强。在这类患者中，术后较小的肿瘤体积与较有利的预后相关。对于剩余的非CE肿瘤，死亡风险呈指数增加。因此，与病变活检相比，广泛切除与较好的生存相关。这些发现在校正人口统计学和临床标志物的多变量分析中得到保留。与CE胶质母细胞瘤相比，非CE胶质母细胞瘤患者具有更有利的临床特征和更好的预后，这在倾向评分分析中通过使用大量临床变量将非CE胶质母细胞瘤患者与CE胶质母细胞瘤患者匹配得到了确认。 对比剂增强的缺失表征了IDH野生型胶质母细胞瘤的较不侵袭性的临床表型。对无对比剂增强肿瘤的最大切除具有预后意义，并且转化为有利的预后。 © 作者（们）2023. 由牛津大学出版社代表神经肿瘤学会发表。

Resection of the contrast-enhancing (CE) tumor represents the standard of care in newly diagnosed glioblastoma. However, some tumors ultimately diagnosed as glioblastoma lack contrast enhancement and have a 'low grade appearance' on imaging (non-CE glioblastoma). We aimed to (I) volumetrically define the value of non-CE tumor resection in the absence of contrast enhancement, and to (II) delineate outcome differences between glioblastoma patients with and without contrast enhancement.The RANO resect group retrospectively compiled a global, eight-center cohort of patients with newly diagnosed glioblastoma per WHO 2021 classification. The associations between post-operative tumor volumes and outcome were analyzed. Propensity score-matched analyses were constructed to compare glioblastomas with and without contrast enhancement.Among 1323 newly diagnosed IDH-wildtype glioblastomas, we identified 98 patients (7.4%) without contrast enhancement. In such patients, smaller post-operative tumor volumes were associated with more favourable outcome. There was an exponential increase in risk for death with larger residual non-CE tumor. Accordingly, extensive resection was associated with improved survival compared to lesion biopsy. These findings were retained on a multivariable analysis adjusting for demographic and clinical markers. Compared to CE glioblastoma, patients with non-CE glioblastoma had more favourable clinical profile and superior outcome as confirmed in propensity score analyses by matching the patients with non-CE glioblastoma to patients with CE glioblastoma using a large set of clinical variables.The absence of contrast enhancement characterizes a less aggressive clinical phenotype of IDH-wildtype glioblastomas. Maximal resection of non-CE tumors has prognostic implications and translates into favourable outcome.© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology.