Health-Related Quality of Life in Glioma Subtypes: A Pooled Analysis of 16 Randomized Trials from the CODAGLIO 2.0 project

Abstract Background It is unclear whether glioma subtypes differ in health-related quality of life (HRQoL) over time. Methods We analyzed data from the CODAGLIO 2.0 database, comprising 16 randomized controlled trials with HRQoL assessed using the EORTC QLQ-C30 and QLQ-BN20 questionnaires. Differences in mean HRQoL at baseline (before postoperative treatments) and 3 months were compared across glioma subtypes. Linear mixed models (LMMs) were used to identify factors independently associated with HRQoL, and anchor-based minimally important differences determined clinical relevance. Results A total of 4,301 patients had baseline HRQoL data; 75% completed follow-up. In stratified analyses, at 3 months, physical, social, role, and cognitive functioning were statistically and clinically significantly worse in glioblastoma than in astrocytoma or oligodendroglioma. In adjusted LMMs, compared with glioblastoma, patients with astrocytoma had worse physical (-2.78, 95% CI -4.68 to -1.01) and cognitive functioning (-3.63, -6.18 to -1.05), more pain (2.74, 0.41–4.95), communication deficits (5.03, 2.44–7.66), and seizures (4.49, 2.55–6.72). Patients with oligodendroglioma had worse social functioning (-5.39, -10.57 to -0.11), communication deficits (7.40, 1.63–12.81), and seizures (8.61, 4.17–14.26). None of these differences exceeded clinical relevance thresholds. Performance status was the only variable associated with clinically meaningful HRQoL changes across most scales. Conclusions At 3 months, patients with glioblastoma show clinically worse HRQoL than IDH-mutant glioma patients in unadjusted analyses. However, after adjusting for clinical variables, glioblastoma patients exhibit statistically but not clinically better HRQoL in several domains. Performance status emerges as the key factor independently associated with HRQoL and should play a central role in clinical decision-making.