Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias - PubMed (original) (raw)
Randomized Controlled Trial
. 2008 Mar;62(3):564-76; discussion 564-76.
doi: 10.1227/01.neu.0000317304.31579.17.
Hanns-Jürgen Reulen, Thomas Meinel, Uwe Pichlmeier, Wiebke Schumacher, Jörg-Christian Tonn, Veit Rohde, Falk Oppel, Bernd Turowski, Christian Woiciechowsky, Kea Franz, Torsten Pietsch; ALA-Glioma Study Group
Collaborators, Affiliations
- PMID: 18425006
- DOI: 10.1227/01.neu.0000317304.31579.17
Randomized Controlled Trial
Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias
Walter Stummer et al. Neurosurgery. 2008 Mar.
Abstract
Objective: The influence of the degree of resection on survival in patients with glioblastoma multiforme is still under discussion. The highly controlled 5-aminolevulinic acid study provided a unique platform for addressing this question as a result of the high frequency of "complete" resections, as revealed by postoperative magnetic resonance imaging scans achieved by fluorescence-guided resection and homogeneous patient characteristics.
Methods: Two hundred forty-three patients with glioblastoma multiforme per protocol from the 5-aminolevulinic acid study were analyzed. Patients with complete and incomplete resections as revealed by early magnetic resonance imaging scans were compared. Prognostic factors that might cause bias regarding resection and influence survival (e.g., tumor size, edema, midline shift, location, age, Karnofsky Performance Scale score, National Institutes of Health Stroke Scale score) were used for analysis of overall survival. Time to reintervention (chemotherapy, reoperation) was analyzed further to exclude bias regarding second-line therapies.
Results: Treatment bias was identified in patients with complete (n = 122) compared with incomplete resection (n = 121), i.e., younger age and less frequent eloquent tumor location. Other factors, foremost preoperative tumor size, were identical. Patients without residual tumor survived longer (16.7 versus 11.8 mo, P < 0.0001). In multivariate analysis, only residual tumor, age, and Karnofsky Performance Scale score were significantly prognostic. To account for distribution bias, patients were stratified for age (>60 or <or=60 yr) and eloquent location. Survival advantages from complete resection remained significant within subgroups, and age/eloquent location were no longer unevenly distributed. Reinterventions occurred marginally earlier in patients with residual tumor (6.7 versus 9.5 mo, P = 0.0582).
Conclusion: Treatment bias was demonstrated regarding resection and second-line therapies. However, bias and imbalances were controllable in the cohorts available from the 5-aminolevulinic acid study so that the present data now provide Level 2b evidence (Oxford Centre for Evidence-based Medicine) that survival depends on complete resection of enhancing tumor in glioblastoma multiforme.
Comment in
- Extent of resection and survival in glioblastoma multiforme: identification of and adjustment for bias.
Stendel R. Stendel R. Neurosurgery. 2009 Jun;64(6):E1206; author reply E1206. doi: 10.1227/01.NEU.0000346230.80425.3A. Neurosurgery. 2009. PMID: 19487874 No abstract available.
Similar articles
- The influence of maximum safe resection of glioblastoma on survival in 1229 patients: Can we do better than gross-total resection?
Li YM, Suki D, Hess K, Sawaya R. Li YM, et al. J Neurosurg. 2016 Apr;124(4):977-88. doi: 10.3171/2015.5.JNS142087. Epub 2015 Oct 23. J Neurosurg. 2016. PMID: 26495941 - Fluorescence-guided resection of glioblastoma multiforme by using 5-aminolevulinic acid-induced porphyrins: a prospective study in 52 consecutive patients.
Stummer W, Novotny A, Stepp H, Goetz C, Bise K, Reulen HJ. Stummer W, et al. J Neurosurg. 2000 Dec;93(6):1003-13. doi: 10.3171/jns.2000.93.6.1003. J Neurosurg. 2000. PMID: 11117842 - Survival and functional status after resection of recurrent glioblastoma multiforme.
Barker FG 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, Wilson CB. Barker FG 2nd, et al. Neurosurgery. 1998 Apr;42(4):709-20; discussion 720-3. doi: 10.1097/00006123-199804000-00013. Neurosurgery. 1998. PMID: 9574634 - Reoperation for Recurrent Glioblastoma Multiforme.
Robin AM, Lee I, Kalkanis SN. Robin AM, et al. Neurosurg Clin N Am. 2017 Jul;28(3):407-428. doi: 10.1016/j.nec.2017.02.007. Neurosurg Clin N Am. 2017. PMID: 28600015 Review. - [The radiosurgery of glioblastoma multiforme in cases of recurrence. The Heidelberg experiences compared to the literature].
van Kampen M, Engenhart-Cabillic R, Debus J, Fuss M, Rhein B, Wannenmacher M. van Kampen M, et al. Strahlenther Onkol. 1998 Jan;174(1):19-24. doi: 10.1007/BF03038223. Strahlenther Onkol. 1998. PMID: 9463560 Review. German.
Cited by
- Advantage and challenges in the use of 5-Aminolevulinic acid (5-ALA) in neurosurgery.
Rybaczek M, Chaurasia B. Rybaczek M, et al. Neurosurg Rev. 2024 Oct 1;47(1):712. doi: 10.1007/s10143-024-02974-0. Neurosurg Rev. 2024. PMID: 39349885 No abstract available. - The role of lobectomy in glioblastoma management: A systematic review and meta-analysis.
Arvaniti CK, Karagianni MD, Papageorgakopoulou MA, Brotis AG, Tasiou A, Fountas KN. Arvaniti CK, et al. Brain Spine. 2024 Apr 23;4:102823. doi: 10.1016/j.bas.2024.102823. eCollection 2024. Brain Spine. 2024. PMID: 39285857 Free PMC article. Review. - Resection versus biopsy in patients with glioblastoma (RESBIOP study): study protocol for an international multicentre prospective cohort study (ENCRAM 2202).
Gerritsen JKW, Young JS, Krieg SM, Jungk C, Ille S, Schucht P, Nahed BV, Broekman MLD, Berger M, De Vleeschouwer S, Vincent AJPE. Gerritsen JKW, et al. BMJ Open. 2024 Sep 10;14(9):e081689. doi: 10.1136/bmjopen-2023-081689. BMJ Open. 2024. PMID: 39260848 Free PMC article. - Metabolic Plasticity of Glioblastoma Cells in Response to DHODH Inhibitor BAY2402234 Treatment.
Bezawork-Geleta A, Moujalled D, De Souza DP, Narayana VK, Dimou J, Luwor R, Watt MJ. Bezawork-Geleta A, et al. Metabolites. 2024 Jul 27;14(8):413. doi: 10.3390/metabo14080413. Metabolites. 2024. PMID: 39195509 Free PMC article. - Comprehensive multimodal deep learning survival prediction enabled by a transformer architecture: A multicenter study in glioblastoma.
Gomaa A, Huang Y, Hagag A, Schmitter C, Höfler D, Weissmann T, Breininger K, Schmidt M, Stritzelberger J, Delev D, Coras R, Dörfler A, Schnell O, Frey B, Gaipl US, Semrau S, Bert C, Hau P, Fietkau R, Putz F. Gomaa A, et al. Neurooncol Adv. 2024 Jul 11;6(1):vdae122. doi: 10.1093/noajnl/vdae122. eCollection 2024 Jan-Dec. Neurooncol Adv. 2024. PMID: 39156618 Free PMC article.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical