Gross-total resection outcomes in an elderly population with glioblastoma: a SEER-based analysis

Clinical article

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  • 1 School of Medicine,
  • 2 Division of Neurological Surgery, and
  • 3 Department of Surgery, University of California, San Diego, California
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Object

There is limited information on the relationship between patient age and the clinical benefit of resection in patients with glioblastoma. The purpose of this study was to use a population-based database to determine whether patient age influences the frequency that gross-total resection (GTR) is performed, and also whether GTR is associated with survival difference in different age groups.

Methods

The authors identified 20,705 adult patients with glioblastoma in the Surveillance, Epidemiology, and End Results (SEER) registry (1998–2009). Surgical practice patterns were defined by the categories of no surgery, subtotal resection (STR), and GTR. Kaplan-Meier and multivariate Cox regression analyses were used to assess the pattern of surgical practice and overall survival.

Results

The frequency that GTR was achieved in patients with glioblastoma decreased in a stepwise manner as a function of patient age (from 36% [age 18–44 years] to 24% [age ≥ 75]; p < 0.001). For all age groups, glioblastoma patients who were selected for and underwent GTR showed a 2- to 3-month improvement in overall survival (p < 0.001) relative to those who underwent STR. These trends remained true after a multivariate analysis that incorporated variables including ethnicity, sex, year of diagnosis, tumor size, tumor location, and radiotherapy status.

Conclusions

Gross-total resection is associated with improved overall survival, even in elderly patients with glioblastoma. As such, surgical decisions should be individually tailored to the patient rather than an adherence to age as the sole clinical determinant.

Abbreviations used in this paper:GTR = gross-total resection; HR = hazard ratio; OR = odds ratio; SEER = Surveillance, Epidemiology, and End Results; STR = subtotal resection.

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Contributor Notes

Mr. Noorbakhsh and Ms. Tang contributed equally to this work. Drs. Chang, Carter, and Chen share senior authorship of this work.

Address correspondence to: Clark Chen, M.D., Ph.D., Division of Neurosurgery, University of California, San Diego, 3855 Health Science Dr.,  0987, La Jolla, CA 92093-0987. email: clarkchen@ucsd.edu.

Please include this information when citing this paper: published online November 8, 2013; DOI: 10.3171/2013.9.JNS13877.

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