TY - JOUR
T1 - Establishing percent resection and residual volume thresholds affecting survival and recurrence for patients with newly diagnosed intracranial glioblastoma
AU - Chaichana, Kaisorn L.
AU - Jusue-Torres, Ignacio
AU - Navarro-Ramirez, Rodrigo
AU - Raza, Shaan M.
AU - Pascual-Gallego, Maria
AU - Ibrahim, Aly
AU - Hernandez-Hermann, Marta
AU - Gomez, Luis
AU - Ye, Xiaobu
AU - Weingart, Jon D.
AU - Olivi, Alessandro
AU - Blakeley, Jaishri
AU - Gallia, Gary L.
AU - Lim, Michael
AU - Brem, Henry
AU - Quinones-Hinojosa, Alfredo
PY - 2014/1
Y1 - 2014/1
N2 - IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.
AB - IntroductionSurgery is first-line therapy for glioblastoma, and there is evidence that gross total resection is associated with improved survival. Gross total resection, however, is not always possible, and relationships among extent (percent) of resection (EOR), residual volume (RV), and survival are unknown. The goals were to evaluate whether there is an association between EOR and RV with survival and recurrence and to establish minimum EOR and maximum RV thresholds.MethodsAdult patients who underwent primary glioblastoma surgery from 2007 to 2011 were retrospectively reviewed. Three-dimensional volumetric tumor measurements were made. Multivariate proportional hazards regression analysis was used to evaluate the relationship between EOR and RV with survival and recurrence.ResultsOf 259 patients, 203 (78%) died and 156 (60%) had tumor recurrence. The median survival and progression-free survival were 13.4 and 8.9 months, respectively. The median (interquartile range) pre- and postoperative tumor volumes were 32.2 (14.0-56.3) and 2.1 (0.0-7.9) cm3, respectively. EOR was independently associated with survival (hazard ratio [HR], 0.995; 95% confidence interval [CI]: 0.990-0.998; P =. 008) and recurrence (HR [95% CI], 0.992 [0.983-0.998], P =. 005). The minimum EOR threshold for survival (P =. 0006) and recurrence (P =. 005) was 70%. RV was also associated with survival (HR [95% CI], 1.019 [1.006-1.030], P =. 004) and recurrence (HR [95% CI], 1.024 [1.001-1.044], P =. 03). The maximum RV threshold for survival (P =. 01) and recurrence (P =. 01) was 5 cm3.ConclusionThis study shows for the first time that both EOR and RV are significantly associated with survival and recurrence, where the thresholds are 70% and 5 cm3, respectively. These findings may help guide surgical and adjuvant therapies aimed at optimizing outcomes for glioblastoma patients.
KW - GBM
KW - extent of resection
KW - glioblastoma
KW - residual
KW - surgery
KW - survival
KW - volumetric
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U2 - 10.1093/neuonc/not137
DO - 10.1093/neuonc/not137
M3 - Article
C2 - 24285550
AN - SCOPUS:84891551641
SN - 1522-8517
VL - 16
SP - 113
EP - 122
JO - Neuro-Oncology
JF - Neuro-Oncology
IS - 1
ER -