Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis
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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.
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.
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.
Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.
KeywordsExtent of resection Surgery Pediatric Glioblastoma GBM Survival
HA and AQH had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. HA is supported by The Prins Bernhard Fonds. AQH is supported by the Howard Hughes Medical Institute (HHMI). The author Jordina Rincon-Torroella is a grant holder for Fundacio “La Caixa” fellowship.
Compliance with ethical standards
Conflict of interest
The authors have no affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest in the subject matter or materials discussed in this manuscript.
HA supported by The Prins Bernhard Fonds. AQH supported by the Howard Hughes Medical Institute (HHMI).
- 5.Artico M, Cervoni L, Celli P, Salvati M, Palma L (1993) Supratentorial glioblastoma in children: a series of 27 surgically treated cases child’s nervous system: ChNS. Off J Int Soc Pediatr Neurosurg 9:7–9Google Scholar
- 6.Bohinski RJ, Kokkino AK, Warnick RE, Gaskill-Shipley MF, Kormos DW, Lukin RR, Tew JM Jr (2001) Glioma resection in a shared-resource magnetic resonance operating room after optimal image-guided frameless stereotactic resection. Neurosurgery 48:731–742 discussion 742-734Google Scholar
- 8.Chastagner P, Kalifa C, Doz F, Bouffet E, Gentet JC, Ruchoux MM, Bracard S, Desandes E, Frappaz D (2007) Outcome of children treated with preradiation chemotherapy for a high-grade glioma: results of a French Society of Pediatric Oncology (SFOP) pilot study. Pediatr Blood Cancer 49:803–807. doi: 10.1002/pbc.21051 CrossRefPubMedGoogle Scholar
- 9.Cohen KJ, Pollack IF, Zhou T, Buxton A, Holmes EJ, Burger PC, Brat DJ, Rosenblum MK, Hamilton RL, Lavey RS, Heideman RL (2011) Temozolomide in the treatment of high-grade gliomas in children: a report from the Children's Oncology Group. Neuro-Oncology 13:317–323. doi: 10.1093/neuonc/noq191 CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Fouladi M, Hunt DL, Pollack IF, Dueckers G, Burger PC, Becker LE, Yates AJ, Gilles FH, Davis RL, Boyett JM, Finlay JL (2003) Outcome of children with centrally reviewed low-grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high-grade glioma study CCG-945. Cancer 98:1243–1252. doi: 10.1002/cncr.11637 CrossRefPubMedGoogle Scholar
- 14.Gorlia T, van den Bent MJ, Hegi ME, Mirimanoff RO, Weller M, Cairncross JG, Eisenhauer E, Belanger K, Brandes AA, Allgeier A, Lacombe D, Stupp R (2008) Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981-22981/CE.3. Lancet Oncol 9:29–38. doi: 10.1016/S1470-2045(07)70384-4 CrossRefPubMedGoogle Scholar
- 15.Hammoud MA, Ligon BL, elSouki R, Shi WM, Schomer DF, Sawaya R (1996) Use of intraoperative ultrasound for localizing tumors and determining the extent of resection: a comparative study with magnetic resonance imaging. J Neurosurg 84:737–741. doi: 10.3171/jns.1996.84.5.0737 CrossRefPubMedGoogle Scholar
- 20.Lesniak MS, Klem JM, Weingart J, Carson BS Sr (2003) Surgical outcome following resection of contrast-enhanced pediatric brainstem gliomas. Pediatr Neurosurg 39:314–322Google Scholar
- 23.Nikitovic M, Stanic D, Pekmezovic T, Gazibara MS, Bokun J, Paripovic L, Grujicic D, Saric M, Miskovic I (2015) Pediatric glioblastoma: a single institution experience. Child’s Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery doi:10.1007/s00381-015-2945-6Google Scholar
- 25.Paugh BS, Qu C, Jones C, Liu Z, Adamowicz-Brice M, Zhang J, Bax DA, Coyle B, Barrow J, Hargrave D, Lowe J, Gajjar A, Zhao W, Broniscer A, Ellison DW, Grundy RG, Baker SJ (2010) Integrated molecular genetic profiling of pediatric high-grade gliomas reveals key differences with the adult disease. J Clin Oncol Off J Am Soc Clin Oncol 28:3061–3068. doi: 10.1200/JCO.2009.26.7252 CrossRefGoogle Scholar
- 31.Sanchez-Herrera F, Castro-Sierra E, Gordillo-Dominguez LF, Vaca-Ruiz MA, Santana-Montero B, Perezpena-Diazconti M, Gonzalez-Carranza V, Torres-Garcia S, Chico-Ponce de Leon F (2009) Glioblastoma multiforme in children: experience at Hospital Infantil de Mexico Federico Gomez Child’s Nervous System: ChNS. Off J Int Soc Pediatr Neurosurg 25:551–557. doi: 10.1007/s00381-008-0780-8 Google Scholar
- 33.Spreeuwenberg MD, Bartak A, Croon MA, Hagenaars JA, Busschbach JJ, Andrea H, Twisk J, Stijnen T (2010) The multiple propensity score as control for bias in the comparison of more than two treatment arms: an introduction from a case study in mental health. Med Care 48:166–174. doi: 10.1097/MLR.0b013e3181c1328f CrossRefPubMedGoogle Scholar
- 37.Wisoff JH, Boyett JM, Berger MS, Brant C, Li H, Yates AJ, McGuire-Cullen P, Turski PA, Sutton LN, Allen JC, Packer RJ, Finlay JL (1998) Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children’s Cancer Group trial no. CCG-945. J Neurosurg 89:52–59. doi: 10.3171/jns.1998.89.1.0052 CrossRefPubMedGoogle Scholar
- 38.Wu G, Broniscer A, McEachron TA, Lu C, Paugh BS, Becksfort J, Qu C, Ding L, Huether R, Parker M, Zhang J, Gajjar A, Dyer MA, Mullighan CG, Gilbertson RJ, Mardis ER, Wilson RK, Downing JR, Ellison DW, Baker SJ (2012) Somatic histone H3 alterations in pediatric diffuse intrinsic pontine gliomas and non-brainstem glioblastomas. Nat Genet 44:251–253. doi: 10.1038/ng.1102 CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Yang T, Temkin N, Barber J, Geyer JR, Leary S, Browd S, Ojemann JG, Ellenbogen RG (2012) Gross total resection correlates with long-term survival in pediatric patients with glioblastoma. World Neurosurgery doi: 10.1016/j.wneu.2012.09.015