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Extent of resection and survival for oligodendroglioma: a U.S. population-based study

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Abstract

Background

National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results.

Objective

To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. population.

Methods

Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets.

Results

3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68–0.97] and HR 0.65 [0.54–0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58–0.95], HR 0.60 [0.44–0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors.

Conclusion

Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.

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Abbreviations

SEER:

Surveillance, Epidemiology, and End-Results

OS:

Overall survival

CSS:

Cause-specific survival

STR:

Subtotal resection

GTR:

Gross total resection

HR:

Hazard ratio

75ST:

75% Survival time

O2:

Grade II oligodendrogliomas

O3:

Grade III oligodendrogliomas

LGG:

Low-grade glioma

HGG:

High-grade glioma

NCCN:

National Comprehensive Cancer Network

EOR:

Extent of resection

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Author notes

  1. Connor J. Kinslow and Andrew L.A. Garton contributed equally to this manuscript and are co-first authors.

Authors and Affiliations

  1. Department of Radiation Oncology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 622 West 168th Street, BNH B011, New York, NY, 10032, USA

    Connor J. Kinslow, Simon K. Cheng & Tony J. C. Wang

  2. Department of Neurological Surgery, NewYork-Presbyterian Hospital / Weill Cornell Medical Center, 525 E 68th Street, New York, NY, 10065, USA

    Andrew L.A. Garton

  3. Department of Neurological Surgery, Oregon Health & Sciences University, 3181 SW Sam Jackson Pkwy, Portland, OR, 97239, USA

    Ali I. Rae

  4. Department of Radiation Oncology, Stanford University, 875 Blake Wilbur Drive, Stanford, CA, 94305, USA

    Logan P. Marcus

  5. Division of Biostatistics, New York State Psychiatric Institute, Columbia University Irving Medical Center, 722 West 168th Street, New York, NY, 10032, USA

    Christopher M. Adams

  6. Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 710 West 168th Street, New York, NY, 10032, USA

    Guy M. McKhann, Michael B. Sisti, E. Sander Connolly & Jeffrey N. Bruce

  7. Herbert Irving Comprehensive Cancer Center, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St Nicholas Ave, New York, NY, 10032, USA

    Guy M. McKhann, Michael B. Sisti, E. Sander Connolly, Jeffrey N. Bruce, Alfred I. Neugut, Peter Canoll, Simon K. Cheng & Tony J. C. Wang

  8. Department of Epidemiology, Mailman School of Public Health, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 722 West 168th St, New York, NY, 10032, USA

    Alfred I. Neugut

  9. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 2210, Chicago, IL, 60611, USA

    Adam M. Sonabend

  10. Departments of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, 1130 St. Nicholas Ave Rm.1001, New York, NY, 10032, USA

    Peter Canoll

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Conflict of interest

No outside funding was received to support this work. Dr. Wang reports personal fees and non-financial support from AbbVie, personal fees and non-financial support from Merck, personal fees from AstraZeneca, personal fees from Doximity, personal fees and non-financial support from Novocure, personal fees and non-financial support from Elekta, personal fees from Cancer Panels, personal fees and non-financial support from RTOG Foundation, and personal fees from Wolters Kluwer, outside the submitted work. Dr. Neugut has served as a Consultant to Pfizer, Teva, Otsuka, Eisai, and United Biosource Corporation and is on the Medical Advisory Board of EHE, Intl.

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Kinslow, C.J., Garton, A.L., Rae, A.I. et al. Extent of resection and survival for oligodendroglioma: a U.S. population-based study. J Neurooncol 144, 591–601 (2019). https://doi.org/10.1007/s11060-019-03261-5

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  • DOI: https://doi.org/10.1007/s11060-019-03261-5

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