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The detrimental effect of biopsy preceding resection in surgically accessible glioblastoma: results from the national cancer database

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Abstract

Purpose

Aggressive resection in surgically-accessible glioblastoma (GBM) correlates with improved survival over less extensive resections. However, the clinical impact of performing a biopsy before definitive resection have not been previously evaluated.

Methods

We analyzed 17,334 GBM patients from the NCDB from 2010–2014. We categorized them into: “upfront resection” and “biopsy followed by resection”. The outcomes of interes included OS, 30-day readmission/mortality, 90-day mortality, and length of hospital stay (LOS). The Kaplan–Meier methods and accelerated failure time (AFT) models were applied for survival analysis. Multivariable binary logistic regression were performed to compare differences among groups. Multiple imputation and propensity score matching (PSM) were conducted for validation.

Results

“Upfront resection” had superior OS over “biopsy followed by resection” (median OS:12.4 versus 11.1 months, log-rank p = 0.001). Similarly, multivariable AFT models favored “upfront resection" (time ratio[TR]:0.83, 95%CI: 0.75–0.93, p = 0.001). Patients undergoing “upfront gross-total resection (GTR)” had higher OS over “upfront subtotal resection (STR)”, “GTR following STR”, and “GTR or STR following initial biopsy” (14.4 vs. 10.3, 13.5, 13.3, and 9.1 months;TR: 1.00 [Ref.], 0.75, 0.82, 0.88, and 0.67). Recent years of diagnosis, higher income, facilities located in Southern regions, and treatment at academic facilities were significantly associated with the higher likelihood of undergoing upfront resection. Multivariable regression showed a decreased 30 and 90-day mortality for patients undergoing “upfront resection”, 73% and 44%, respectively (p < 0.001).

Conclusions

Pre-operative biopsies for surgically accessible GBM are associated with worse survival despite subsequent resection compared to patients undergoing upfront resection.

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Data availability

The National Cancer Database would be available for data application from https://www.facs.org/quality-programs/cancer-programs/national-cancer-database/.

Code availability

Not applicable.

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Acknowledgements

Partial results of the present study were presented at the 25th annual meeting of the Society for Neuro-Oncology (SNO), in November 2020, in Austin, Texas.

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Authors and Affiliations

  1. The Vivian L. Smith Department of Neurosurgery and Center for Precision Health, The University of Texas Health Science Center at Houston McGovern Medical School, 6400 Fannin Street, Suite # 2800, Houston, TX, 77030, USA

    Ping Zhu, Pavel S. Pichardo-Rojas, Antonio Dono, Nitin Tandon & Yoshua Esquenazi

  2. Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Constantinos G. Hadjipanayis

  3. Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, CA, USA

    Mitchel S. Berger

Authors
  1. Ping Zhu
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  2. Pavel S. Pichardo-Rojas
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  5. Constantinos G. Hadjipanayis
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  7. Yoshua Esquenazi
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Contributions

Study design: Data collection: Data analysis: Manuscript draft writing: Manuscript editing: Manuscript approval: all authors.

Corresponding author

Correspondence to Yoshua Esquenazi.

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Zhu, P., Pichardo-Rojas, P.S., Dono, A. et al. The detrimental effect of biopsy preceding resection in surgically accessible glioblastoma: results from the national cancer database. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04644-z

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