Comparison of Survival Outcomes Between Partial Resection and Biopsy for Primary Glioblastoma: A Propensity Score-Matched Study

World Neurosurg. 2019 Jan:121:e858-e866. doi: 10.1016/j.wneu.2018.09.237. Epub 2018 Oct 11.

Abstract

Objectives: Gross total resection for glioblastoma (GBM) has been associated with better prognosis. However, it is not always feasible, and the threshold for the extent of resection required for better prognosis has been controversial. Therefore, we compared the survival and clinical outcomes of patients with GBM who had undergone partial resection (PR) or biopsy.

Methods: Of the 110 patients, 32 and 78, who had undergone PR and biopsy, respectively, were enrolled to identify any differences in clinical outcomes. No differences were found in patient demographics between the 2 groups, except for tumor location and mean tumor volume (P = 0.02 and P < 0.01, respectively). Propensity score matching between the PR and biopsy groups was performed, in which 20 patients each in the PR and biopsy groups were matched.

Results: The overall survival (OS) and progression-free survival (PFS) did not differ significantly between the PR and biopsy groups (P = 0.84 and P = 0.48, respectively). After propensity score matching, the differences in OS and PFS between the 2 groups were still not statistically significant (P = 0.51 and P = 0.75, respectively). The hazard ratios for OS and PFS for the PR group compared with biopsy were 0.98 and 0.73, respectively; however, the difference was not statistically significant (P = 0.96 and P = 0.39, respectively). The surgical complication rate was greater in the PR group (14 of 32; 43.7%) than in the biopsy group (9 of 78; 11.5%; P < 0.01).

Conclusions: PR failed to improve survival compared with biopsy for patients with GBM. Moreover, the surgical complication rate in the PR group was greater than that in the biopsy group.

Keywords: Biopsy; Glioblastoma; Partial resection; Survival.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Brain Neoplasms / diagnostic imaging
  • Brain Neoplasms / mortality*
  • Brain Neoplasms / surgery*
  • DNA Methylation
  • DNA Modification Methylases / genetics
  • DNA Repair Enzymes / genetics
  • Female
  • Follow-Up Studies
  • Glioblastoma / diagnostic imaging
  • Glioblastoma / mortality*
  • Glioblastoma / surgery*
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Neurosurgical Procedures / methods
  • Progression-Free Survival
  • Propensity Score*
  • Treatment Outcome
  • Tumor Suppressor Proteins / genetics
  • Young Adult

Substances

  • Tumor Suppressor Proteins
  • DNA Modification Methylases
  • MGMT protein, human
  • DNA Repair Enzymes