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Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based
Hadie Adams1,2, Hieab H H Adams3, Christina Jackson1
1Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
Insights
Gross total resection (GTR) significantly improves survival for pediatric glioblastoma patients. This study highlights the importance of maximal surgical resection for better outcomes in this young population.
Area of Science:
- Neuro-oncology
- Pediatric oncology
- Surgical oncology
Background:
- Glioblastoma (GB) is a challenging brain tumor, particularly in pediatric patients.
- The optimal extent of resection (EOR) for pediatric glioblastoma (pGB) remains debated.
- Adult GB data is not generalizable to pediatric populations.
Purpose of the Study:
- To compare the effectiveness of different extents of resection (EOR) in pediatric glioblastoma (pGB) patients.
- To analyze the impact of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival.
- To provide data specific to pediatric populations, addressing a gap in the literature.
Main Methods:
- Utilized the Surveillance, Epidemiology, and End Results (SEER) cancer registry (1988-2009).
- Included 342 pediatric glioblastoma patients.
- Employed multivariate and multiple propensity score (mPS)-adjusted analyses to assess survival.
Main Results:
- Gross total resection (GTR) was performed in 35.4% of patients.
- Extent of resection (EOR) was a significant predictor of survival (P < 0.001).
- Patients undergoing GTR had significantly lower mortality risk compared to partial resection (PR) or biopsy (Bx).
Conclusions:
- Gross total resection (GTR) is independently associated with improved survival in pediatric glioblastoma patients.
- Maximal surgical resection should be considered a key component of treatment.
- Further research into pGB treatment strategies is warranted.
Purpose:
The benefit of radical resections for glioblastoma patients remains a source of contention in the literature. Few studies have been conducted in pediatric patients, and it is becoming increasingly evident that data regarding adult glioblastoma (GB) patients cannot be generalized to pediatric patients affected by this neoplasm. A comparative effectiveness study is performed for different extent of resection (EOR) groups in the largest cohort of pediatric GB (pGB) patients.
Methods:
The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used to identify pGB patients from 1988 through 2009. Multivariate- and multiple propensity score (mPS)-adjusted analyses were used to determine the effect of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival. Survival prospects were summarized using direct adjusted survival curves.
Results:
A total of 342 pGB patients were identified, and 35.4 % of patients received a GTR, 28.8 % PR, 17.3 % Bx, and 17.0 % did not undergo surgery. In our cohort, a median overall survival of 12 months was observed with 1-, 2-, and 5-year survival rates of 51.7, 28.3, and 15.7 %, respectively. EOR was a predictor of survival in both the multivariate- (P < 0.001) and mPS-adjusted model (P < 0.001). Compared to the GTR group, a higher mortality rate was observed in patients who underwent a PR (HR 1.50; 95 % CI, 1.02-2.21) or Bx (HR 1.87; 95 % CI, 1.18-2.98). There were no significant differences in (adjusted) mortality risk between the PR and Bx groups.
Conclusion:
Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.
