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



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.


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.


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.


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.

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

Author information




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.

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Correspondence to Debraj Mukherjee.

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Importance of the study

In this study, we utilized the SEER database to explore the survival of adult patients with brainstem astrocytic HGGs. This study is the largest study to date to elucidate survival postsurgical intervention for this extremely rare disease. We managed to find that age and extent of resection were associated with survival in this patient cohort. GTR/TR was associated with double the survival of biopsy patients. This study provides a more reliable overall survival estimate for these patients due to the large sample size.

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Doyle, J., Khalafallah, A.M., Yang, W. et al. Association between extent of resection on survival in adult brainstem high-grade glioma patients. J Neurooncol 145, 479–486 (2019).

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  • Brainstem
  • High-grade glioma
  • Glioblastoma
  • SEER
  • Survival