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58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

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Extent of resection and survival in glioblastoma multiforme

Einfluss der Resektion auf das Überleben bei Patienten mit Glioblastoma multiforme

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  • corresponding author W. Stummer - Neurochirurgische Klinik, Universitätsklinikum Düsseldorf
  • T. Meinel - Clinstud GmbH, Hamburg
  • U. Pichlmeier - Medac GmbH, Wedel
  • J.-C. Tonn - Neurochiurgische Klinik, Ludwig-Maximilians-Universität, München
  • V. Rohde - Neurochirurgische Klinik, Georg-August-Universität Göttingen
  • ALA-Glioma Study Group
  • H.-J. Reulen - Neurochiurgische Klinik, Ludwig-Maximilians-Universität, München

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocFR.04.04a

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2007/07dgnc089.shtml

Published: April 11, 2007

© 2007 Stummer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: The influence of resection on survival in glioblastoma multiforme patients is still under discussion. The highly controlled ALA study provided a unique platform for readdressing this question due to the high frequency of “complete“ resections on early post-operative MRI achieved in this study and its homogeneous study population.

Methods: Data on 243 per protocol glioblastoma multiforme patients from the ALA study were analyzed, comparing patients with complete and incomplete resections on early MRI. Prognostic factors were identified that might cause selection bias while influencing survival (e.g. tumor size, edema, midline shift, age, KPS, NIH stroke score, location, residual tumor) and used for analysis of overall survival. Time to reintervention (chemotherapy, reoperation) was further analyzed to rule out bias concerning second-line therapies.

Results: Patients with complete (n=122) and incomplete resections (n=121) were balanced in all aspects except age and eloquent tumor location. Patients with residual tumor survived longer than patients with residual tumor (16.7 vs 11.8 months, p<0.0001, HR 0.54). In multivariate analysis only residual tumor, age and KPS were significantly prognostic. To account for selection bias patients were stratified for age (> or ≤60 ys) and eloquent location. Survival advantages from complete resections remained significant within these subgroups. Patients with residual tumor received reinterventions significantly earlier.

Conclusions: Because of the strong homogeneity of patients selection bias was small and controllable in the ALA study, so that the present data provide the highest level of evidence so far that survival depends on complete resections of enhancing tumor in glioblastoma multiforme patients.