Treatment and surgical factors associated with longer-term glioblastoma survival: a National Cancer Database study

Sindhoosha Malay; Eashwar Somasundaram; Nirav Patil; Robin Buerki; Andrew Sloan; Jill S Barnholtz-Sloan

doi:10.1093/noajnl/vdaa070

Treatment and surgical factors associated with longer-term glioblastoma survival: a National Cancer Database study

Neurooncol Adv. 2020 Jun 4;2(Suppl 1):1-10. doi: 10.1093/noajnl/vdaa070. eCollection 2020 Jul.

Authors

Sindhoosha Malay¹, Eashwar Somasundaram¹, Nirav Patil^{1

2}, Robin Buerki³, Andrew Sloan⁴, Jill S Barnholtz-Sloan^{1

2}

Affiliations

¹ Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
² Research Division, University Hospitals of Cleveland, Cleveland, Ohio, USA.
³ Department of Neurology, University Hospitals of Cleveland, Cleveland, Ohio, USA.
⁴ Department of Neurological Surgery, University Hospitals of Cleveland, Cleveland, Ohio, USA.

Abstract

Background: Insufficient data exist to characterize factors associated with longer-term survival of glioblastoma (GBM). A population-based analysis of GBM longer-term survivors (LTS) in the United States was conducted to investigate the association between treatment, demographic, surgical factors, and longer-term survival.

Methods: From the National Cancer Database, GBM patients were identified using ICD-O-3 histology codes 9440-9442/3, 2005-2015 and were divided into routine (≤3 years) and longer-term (>3 years) overall survival (OS) groups. Univariable and multivariable logistic regression analysis was used to assess factors associated with longer-term survival. A subset analysis was performed to further investigate the association of extent of resection and treatment combinations on OS outcomes.

Results: A total of 93 036 patients with GBM met study criteria. Among these patients, 8484 were LTS and 84 552 were routine survivors (RS). When comparing LTS (OS of >3 years) with RS (OS of ≤3 years), younger age, insured status, metro/urban residence, treatment at academic facility, and fewer comorbidities were associated with longer-term survival. In addition, trimodality therapy (chemotherapy + radiation + surgery) was associated with having best odds of longer-term survival (odds ratio = 4.89, 95% confidence interval [3.58, 6.68]); 74% of LTS received such therapy compared with 51% of RS. Subset analysis revealed that total resection is only associated with longer-term survival status for those receiving trimodality therapy or surgery only.

Conclusions: In a population-based analysis, standard of care surgery and chemo radiation connote a survival advantage in GBM. Among those receiving standard of care, having a total resection is most beneficial for longer-term survival status.

Keywords: glioblastoma; longer-term survival; subtotal resection; total resection; trimodality therapy.