Child's Nervous System

, Volume 32, Issue 3, pp 493–503 | Cite as

Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis

  • Hadie Adams
  • Hieab H. H. Adams
  • Christina Jackson
  • Jordina Rincon-Torroella
  • George I. Jallo
  • Alfredo Quiñones-Hinojosa
Original Paper



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.


Extent of resection Surgery Pediatric Glioblastoma GBM Survival 


Author contributions

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).

Supplementary material

381_2015_3006_MOESM1_ESM.doc (45 kb)
Online Resource 1 (DOC 45 kb)
381_2015_3006_Fig4_ESM.gif (29 kb)

(GIF 20 kb)

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High resolution image (EPS 146 kb)
381_2015_3006_MOESM3_ESM.doc (42 kb)
Online Resource 2 – Figure legend (DOC 27 kb)
381_2015_3006_MOESM4_ESM.doc (28 kb)
Online Resource 2 - Results (DOC 41 kb)
381_2015_3006_MOESM5_ESM.pdf (776 kb)
ESM 5 (PDF 775 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Hadie Adams
    • 1
    • 2
  • Hieab H. H. Adams
    • 3
  • Christina Jackson
    • 1
  • Jordina Rincon-Torroella
    • 1
  • George I. Jallo
    • 1
  • Alfredo Quiñones-Hinojosa
    • 1
  1. 1.Department of Neurosurgery and OncologyJohns Hopkins School of MedicineBaltimoreUSA
  2. 2.Division of Neurosurgery, Department of Clinical NeurosciencesAddenbrooke’s Hospital and University of CambridgeCambridgeUK
  3. 3.Division of Neuro-Epidemiology, Department of EpidemiologyErasmus Medical CenterRotterdamThe Netherlands

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