Background/Objective: Gliomas are the most common primary brain tumors in adults, with recurrence rates varying by tumor grade and initial treatment. Reoperation is a key strategy for managing recurrence; however, its impact on functional status and health-related quality of life (HRQoL) remains insufficiently defined. While HRQoL and neurocognitive outcomes have been described after primary treatment, far less is known following reoperation. This systematic review synthesizes available evidence on postoperative functional outcomes and summarizes HRQoL reporting in the reoperation literature. Methods: A systematic search of PubMed and Google Scholar retrieved 1336 articles. After removing duplicates (n= 76) and screening full texts (n= 42), 15 studies (totaln= 1934; reoperation groupn= 947) met the inclusion criteria. Studies were eligible if they employed validated functional or HRQoL instruments (e.g., Karnofsky Performance Status [KPS], FACT-G, SF-36, and EQ-5D-L). Due to limited and heterogeneous HRQoL reporting, only KPS could be aggregated for meta-analysis, and HRQoL measures were descriptively summarized. Results: Fixed-effect meta-analysis demonstrated a modest decline in postoperative KPS compared with preoperative scores (−3.28, 95% CI: −3.69 to −2.86;p< 0.001), though heterogeneity was high (I2≈ 97%). The random-effects model, accounting for interstudy variability, showed no significant overall change (+0.16 KPS, 95% CI: −4.04 to +4.35;p= 0.94; I2≈ 48%). The 95% prediction interval (−14.1 to +14.4) indicated that individual centers may observe either improvement or decline. Sensitivity analyses identified a small outlier study as a major contributor to heterogeneity; its exclusion did not materially alter the results. Conclusions: Across heterogeneous observational cohorts, reoperation for recurrent glioma was not associated with a consistent decline in functional status as measured by KPS, although substantial variability and uncertainty in outcomes remain. HRQoL reporting remains sparse and inconsistent, underscoring the need for prospective, multicenter studies employing standardized HRQoL instruments to better define quality-of-life trajectories after reoperation.
背景/目的：胶质瘤是成人最常见的原发性脑肿瘤，其复发率因肿瘤分级和初始治疗而异。再次手术是处理复发的重要策略，但其对功能状态和健康相关生活质量的影响仍未明确。虽然已有研究描述了初次治疗后的HRQoL和神经认知结局，但关于再次手术后的情况所知甚少。本系统综述综合了术后功能结局的现有证据，并总结了再次手术文献中HRQoL的报告情况。方法：系统检索PubMed和Google Scholar数据库，共获得1336篇文献。去除重复文献（76篇）并筛选全文（42篇）后，15项研究（总样本量1934例；再次手术组947例）符合纳入标准。纳入研究需使用经过验证的功能或HRQoL评估工具（如Karnofsky功能状态评分、FACT-G、SF-36、EQ-5D-L）。由于HRQoL报告有限且异质性高，仅KPS评分可进行荟萃分析，HRQoL指标则进行描述性总结。结果：固定效应模型荟萃分析显示术后KPS评分较术前略有下降（-3.28，95% CI：-3.69至-2.86；p<0.001），但异质性较高（I²≈97%）。考虑研究间变异性的随机效应模型显示总体变化不显著（+0.16 KPS，95% CI：-4.04至+4.35；p=0.94；I²≈48%）。95%预测区间（-14.1至+14.4）表明不同中心可能观察到功能改善或下降。敏感性分析发现一项小型离群研究是异质性的主要来源，排除该研究未实质性改变结果。结论：在异质性观察队列中，针对复发性胶质瘤的再次手术并未导致KPS评估的功能状态出现一致性下降，但结局仍存在显著变异性和不确定性。HRQoL报告仍然稀少且不一致，凸显需要采用标准化HRQoL工具开展前瞻性多中心研究，以更好界定再次手术后的生活质量变化轨迹。
肿瘤(癌症)患者之家