Advertisement

Association between extent of resection on survival in adult brainstem high-grade glioma patients

  • Joshua Doyle
  • Adham M. Khalafallah
  • Wuyang Yang
  • Yi Sun
  • Chetan Bettegowda
  • Debraj MukherjeeEmail author
Clinical Study

Abstract

Background

Brainstem high-grade gliomas (HGG) are rare lesions with aggressive behavior that pose significant treatment challenges. The operative use of brainstem safe entry zones has made such lesions surgically accessible, though the benefits of aggressive resection have been unclear. This study aimed to clarify the survival in adult patients.

Methods

We utilized the SEER database (1973–2015) to analyze the association between survival and demographic data, tumor characteristics, and treatment factors in adult patients with brainstem HGGs. Patients without surgical intervention were excluded. Overall survival (OS) was analyzed using univariable and multivariable Cox regression.

Results

Our dataset included a total of 502 brainstem HGG patients of which only those who had undergone surgical intervention were included in the analysis, totaling 103. Mean age was 42.4 ± 14.1 years with 57.2% (n = 59) male. Median OS of the entire cohort was 11.0 months. Median OS for patients receiving biopsy, subtotal resection, and gross total resection were 8, 11, and 16 months, respectively. Age, extent of resection, and radiation therapy were selected into the multivariable model. A significant decrease in survival was seen in older patients, 50–60 years (HR = 2.77, p = 0.002) and ≥ 60 years (HR = 5.30, p < 0.001), compared to younger patients (18–30 years). Partial resection (HR = 0.32, p = 0.006) and GTR (HR = 0.24, p < 0.001) sustained survival benefits compared to patients with biopsy only. Patients receiving postoperative radiation demonstrated no survival benefit (HR = 1.57, p = 0.161) in multivariable regression.

Conclusions

While survival of brainstem HGG patients remains poor, for surgically accessible HGGs, STR and GTR were associated with a three and fourfold increase in overall survival when compared to biopsy only.

Keywords

Brainstem High-grade glioma Glioblastoma SEER Survival 

Notes

Author contributions

Conception or design of the work: JD, AMK, WY, DM. Data collection: JD, WY. Data analysis and interpretation: AMK, WY, YS. Drafting the article: JD, AMK, WY, YS, CB, DM. Critical revision of the article: CB, DM. Final approval of the version to be published: AMK, DM.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest or financial disclosures.

Supplementary material

11060_2019_3313_MOESM1_ESM.docx (18 kb)
Supplementary file1 (DOCX 18 kb)
11060_2019_3313_MOESM2_ESM.docx (14 kb)
Supplementary file2 (DOCX 14 kb)
11060_2019_3313_MOESM3_ESM.docx (16 kb)
Supplementary file3 (DOCX 15 kb)
11060_2019_3313_MOESM4_ESM.docx (20 kb)
Supplementary file4 (DOCX 19 kb)
11060_2019_3313_MOESM5_ESM.docx (35 kb)
Supplementary file5 (DOCX 35 kb)

References

  1. 1.
    Tokuriki Y, Handa H, Yamashita J, Okumura T, Paine JT (1986) Brainstem glioma: an analysis of 85 cases. Acta Neurochir (Wien) 79(2–4):67–73CrossRefGoogle Scholar
  2. 2.
    Babu R, Kranz PG, Agarwal V et al (2014) Malignant brainstem gliomas in adults: clinicopathological characteristics and prognostic factors. J Neurooncol 119(1):177–185CrossRefGoogle Scholar
  3. 3.
    Guillamo JS, Monjour A, Taillandier L et al (2001) Brainstem gliomas in adults: prognostic factors and classification. Brain 124(Pt 12):2528–2539CrossRefGoogle Scholar
  4. 4.
    Ostrom QT, Bauchet L, Davis FG et al (2014) The epidemiology of glioma in adults: a “state of the science” review. Neuro-oncology 16(7):896–913CrossRefGoogle Scholar
  5. 5.
    Theeler BJ, Gilbert MR (2015) Advances in the treatment of newly diagnosed glioblastoma. BMC Med 13(1):293CrossRefGoogle Scholar
  6. 6.
    Eisele SC, Reardon DA (2016) Adult brainstem gliomas. Cancer 122(18):2799–2809CrossRefGoogle Scholar
  7. 7.
    Hassan H, Pinches A, Picton SV, Phillips RS (2017) Survival rates and prognostic predictors of high grade brain stem gliomas in childhood: a systematic review and meta-analysis. J Neurooncol 135(1):13–20CrossRefGoogle Scholar
  8. 8.
    Mukherjee D, Antar V, Soylemez B et al (2018) High-resolution diffusion tensor magnetic resonance imaging of the brainstem safe entry zones. Neurosurg Rev 68(2):403–415Google Scholar
  9. 9.
    Dey M, Lin Y, Melkonian S, Lam S (2014) Prognostic factors and survival in primary adult high grade brainstem astrocytoma: a population based study from 1973–2008. J Clin Neurosci 21(8):1298–1303CrossRefGoogle Scholar
  10. 10.
    deLeeuw J (1992) Introduction to Akaike (1973) information theory and an extension of the maximum likelihood principle (PDF). In: Kotz S, Johnson NL (eds) Breakthroughs in statistics I. Springer, New York, pp 599–609CrossRefGoogle Scholar
  11. 11.
    Bozdogan H (1987) Model selection and Akaike's information criterion (AIC): the general theory and its analytical extensions. Psychometrika 52:345CrossRefGoogle Scholar
  12. 12.
    Fisher PG, Breiter SN, Carson BS et al (2000) A clinicopathologic reappraisal of brain stem tumor classification Identification of pilocystic astrocytoma and fibrillary astrocytoma as distinct entities. Cancer 89(7):1569–1576CrossRefGoogle Scholar
  13. 13.
    Bricolo A (2000) Surgical management of intrinsic brain stem gliomas. Oper Techn Neurosurg 3(2):137–154CrossRefGoogle Scholar
  14. 14.
    Reyes-Botero G, Mokhtari K, Martin-Duverneuil N, Delattre J-Y, Laigle-Donadey F (2012) Adult brainstem gliomas. Oncologist 17(3):388–397CrossRefGoogle Scholar
  15. 15.
    Theeler BJ, Ellezam B, Melguizo-Gavilanes I et al (2015) Adult brainstem gliomas: correlation of clinical and molecular features. J Neurol Sci 353(1–2):92–97CrossRefGoogle Scholar
  16. 16.
    Hu J, Western S, Kesari S (2016) Brainstem glioma in adults. Front Oncol 6(26):180PubMedPubMedCentralGoogle Scholar
  17. 17.
    Lesniak MS, Klem JM, Weingart J, Carson BS (2003) Surgical outcome following resection of contrast-enhanced pediatric brainstem gliomas. Pediatr Neurosurg 39(6):314–322CrossRefGoogle Scholar
  18. 18.
    Cavalheiro S, Yagmurlu K, da Costa MDS et al (2015) Surgical approaches for brainstem tumors in pediatric patients. Childs Nerv Syst 31(10):1815–1840CrossRefGoogle Scholar
  19. 19.
    Lassiter KR, Alexander E, Davis CH, Kelly DL (1971) Surgical treatment of brain stem gliomas. J Neurosurg 34(6):719–725CrossRefGoogle Scholar
  20. 20.
    Epstein F, McCleary EL (1986) Intrinsic brain-stem tumors of childhood: surgical indications. J Neurosurg 64(1):11–15CrossRefGoogle Scholar
  21. 21.
    Kestle J, Townsend JJ, Brockmeyer DL, Walker ML (2004) Juvenile pilocytic astrocytoma of the brainstem in children. J Neurosurg 101(1 Suppl):1–6PubMedGoogle Scholar
  22. 22.
    Teo C, Siu TL (2008) Radical resection of focal brainstem gliomas: is it worth doing? Childs Nerv Syst 24(11):1307–1314CrossRefGoogle Scholar
  23. 23.
    McGirt MJ, Mukherjee D, Chaichana KL, Than KD, Weingart JD, Quinones-Hinojosa A (2009) association of surgically acquired motor and language deficits on overall survival after resection of glioblastoma multiforme. Neurosurgery 65(3):463–470CrossRefGoogle Scholar
  24. 24.
    Rahman M, Abbatematteo J, Leo EKD et al (2016) The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma. J Neurosurg 127(1):123–131CrossRefGoogle Scholar
  25. 25.
    Killela PJ, Reitman ZJ, Jiao Y et al (2013) TERT promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal. Proc Natl Acad Sci USA 110(15):6021–6026CrossRefGoogle Scholar
  26. 26.
    Eckel-Passow JE, Lachance DH, Molinaro AM et al (2015) Glioma groups based on 1p/19q, IDH, and TERT promoter mutations in tumors. N Engl J Med 372(26):2499–2508CrossRefGoogle Scholar
  27. 27.
    Network Cancer Genome Atlas Research, Brat DJ, Verhaak RGW et al (2015) Comprehensive, integrative genomic analysis of diffuse lower-grade gliomas. N Engl J Med 372(26):2481–2498CrossRefGoogle Scholar
  28. 28.
    Kim H, Zheng S, Amini SS et al (2015) Whole-genome and multisector exome sequencing of primary and post-treatment glioblastoma reveals patterns of tumor evolution. Genome Res 25(3):316–327CrossRefGoogle Scholar
  29. 29.
    Louis DN, Perry A, Reifenberger G et al (2016) The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol 131(6):803–820CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryJohns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

Personalised recommendations