Patient age is related to favorable association of supramaximal resection with outcome in glioblastoma
Nico Teske (Erlangen; München), Antonio Dono (Houston, TX / US), Jacob S. Young (San Francisco, CA / US), Stephanie T. Jünger (Köln), Gilbert C. Youssef (Boston, MA / US), Levin Häni (Freiburg; Bern / CH), Tommaso Sciortino (Mailand / IT), Francesco Bruno (Turin / IT), Jorg Dietrich (Boston, MA / US), Christine Y Mau (Tampa, FL / US), Michael Weller (Zürich / CH), Jürgen Beck (Freiburg), Shawn Hervey-Jumper (San Francisco, CA / US), Annette M. Molinaro (San Francisco, CA / US), Susan M. Chang (San Francisco, CA / US), Martin van den Bent (Rotterdam / NL), Michael A. Vogelbaum (Tampa, FL / US), Daniel P. Cahill (Boston, MA / US), Roberta Rudà (Turin / IT), Lorenzo Bello (Mailand / IT), Oliver Schnell (Erlangen; Freiburg), Niklas Thon (München), Raymond Y. Huang (Boston, MA / US), Patrick Y. Wen (Boston, MA / US), Maximilian Ruge (Köln), Stefan J. Grau (Köln; Fulda), Nitin Tandon (Houston, TX / US), Mitchel S. Berger (San Francisco, CA / US), Joerg-Christian Tonn (München), Yoshua Esquenazi (Houston, TX / US), Philipp Karschnia (Erlangen; München)
The oncological role of resection in elderly patients with glioblastoma remains controversial as various studies have produced conflicting results. Here, we aimed to evaluate the oncological role of resection in patients ≥65 years with (I) newly diagnosed and (II) recurrent glioblastoma by exploring the prognostic relevance for extent of resection when compared to patients <65 years.
We retrospectively compiled large cohorts of patients with newly diagnosed and recurrent IDH-wildtype glioblastoma from ten neuro-oncological centers. Associations between residual tumor and other molecular and clinical markers on survival were analyzed. Propensity score-matched analyses were performed to minimize confounding effects while comparing extents of resection.
1260 patients with newly diagnosed glioblastoma were collected, including 512 elderly patients defined as ≥65 years of age. Lower postoperative contrast-enhancing tumor volume was favorably associated with survival on uni- and multivariate analyses in both patient cohorts while its association with survival was substantially more pronounced in younger patients (HR/10cm3 tumor remnant: 1.39, 95%-CI: 1.25-1.51 vs. 1.28, 95%-CI: 1.19-1.36). With higher contrast-enhancing tumor remnants, overall and progression-free survival was generally less favorable in patients ≥65 years compared to younger patients (OS: 13 [95%-CI: 12-14] vs. 20 [19-22] months, p = 0.001). Supramaximal resection beyond the enhancing tumor borders translated into more favorable survival only in patients <65 years (OS: 32 [95%-CI: 18-40] vs. 19 [17-21] months, p = 0.001). In 310 patients (including 92 patients ≥65 years) with first recurrence of a previously resected glioblastoma, associations of residual contrast-enhancing tumor were also less pronounced in elderly patients while neither in elderly nor in younger patients definitive evidence for a favorable effect of supramaximal resection was demonstrated in this cohort. These findings were confirmed in propensity score-matched analyses.
While residual contrast-enhancing tumor is prognostic for outcome also in elderly patients ≥65 years, the associations of more extensive resection with outcome are less pronounced compared to younger patients. Those findings highlight the relevance of a tailored approach for resection in elderly patients, and may support surgical decision-making with special attention to patient age.
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