Interaction Between the Contributions of Tumor Location, Tumor Grade, and Patient Age to the Survival Benefit Associated with Gross Total Resection

Kate T Carroll; Alex K Bryant; Brian Hirshman; Ali A Alattar; Rushikesh Joshi; Brandon Gabel; Bob S Carter; Olivier Harismendy; Florin Vaida; Clark C Chen

doi:10.1016/j.wneu.2017.12.165

Interaction Between the Contributions of Tumor Location, Tumor Grade, and Patient Age to the Survival Benefit Associated with Gross Total Resection

World Neurosurg. 2018 Mar:111:e790-e798. doi: 10.1016/j.wneu.2017.12.165. Epub 2018 Jan 5.

Authors

Affiliations

¹ School of Medicine, University of California, San Diego, San Diego, California, USA.
² Department of Neurosurgery, University of California, San Diego, San Diego, California, USA.
³ Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA.
⁴ Moores Cancer Center, University of California, San Diego, San Diego, California, USA.
⁵ Department of Family Medicine and Public Health, University of California, San Diego, San Diego, California, USA.
⁶ Department of Neurosurgery, University of California, San Diego, San Diego, California, USA; Moores Cancer Center, University of California, San Diego, San Diego, California, USA. Electronic address: ccchen@umn.edu.

PMID: 29309983
DOI: 10.1016/j.wneu.2017.12.165

Abstract

Background: Gross total resection (GTR) in patients with glioblastoma (GB) and anaplastic astrocytoma (AA) is associated with improved survival. We examined how tumor location, tumor grade, and age affected this benefit.

Methods: We selected patients with lobar AA or GB in the Surveillance, Epidemiology, and End Results database from 1999 to 2010. Survival analyses were performed using Kaplan-Meier curves and Cox proportional hazards models.

Results: We identified and studied 1429 patients with lobar AA and 12,537 patients with lobar GB in the Surveillance, Epidemiology, and End Results database. In multivariate Cox proportional hazards analysis, GTR of frontal lobe AA was associated with approximately 50% reduction in risk of death compared with subtotal resection (STR) (hazard ratio 0.51; 95% confidence interval, 0.36-0.73; P < 0.001). This hazard ratio corresponds to a median increase in overall survival of >8 years with GTR compared with STR. In nonfrontal AAs, there was no survival difference between GTR and STR (hazard ratio 0.79; 95% confidence interval, 0.58-1.08; P = 0.143). Location-specific survival benefit from GTR in AAs was significant in patients ≤50 years old but was not evident in patients >50 years old. In patients with GB, no location-dependent survival benefit with GTR was observed.

Conclusions: Our results demonstrate complex interaction between tumor grade, frontal lobe location, and age in their various contributions to survival benefit gained from GTR. The greatest survival benefit of GTR relative to STR was observed in patients ≤50 years old with frontal AAs.

Keywords: Age; Glioma; Gross total resection; IDH; Tumor location; WHO grade.

MeSH terms

Adult
Age Factors
Aged
Astrocytoma / mortality
Astrocytoma / surgery*
Brain Neoplasms / mortality
Brain Neoplasms / surgery*
Databases, Factual
Female
Glioblastoma / mortality
Glioblastoma / surgery*
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Neoplasm Grading
Neurosurgical Procedures / methods*
Retrospective Studies
Survival Analysis
Treatment Outcome