The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma

PurposeThe role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for ad...

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Main Authors: Zhuoyi Liu, Songshan Feng, Jing Li, Hui Cao, Jun Huang, Fan Fan, Li Cheng, Zhixiong Liu, Quan Cheng
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-03-01
Series:Frontiers in Oncology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2021.566972/full
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author Zhuoyi Liu
Zhuoyi Liu
Zhuoyi Liu
Songshan Feng
Songshan Feng
Songshan Feng
Jing Li
Hui Cao
Jun Huang
Jun Huang
Fan Fan
Fan Fan
Fan Fan
Li Cheng
Zhixiong Liu
Zhixiong Liu
Quan Cheng
Quan Cheng
Quan Cheng
author_facet Zhuoyi Liu
Zhuoyi Liu
Zhuoyi Liu
Songshan Feng
Songshan Feng
Songshan Feng
Jing Li
Hui Cao
Jun Huang
Jun Huang
Fan Fan
Fan Fan
Fan Fan
Li Cheng
Zhixiong Liu
Zhixiong Liu
Quan Cheng
Quan Cheng
Quan Cheng
author_sort Zhuoyi Liu
collection DOAJ
description PurposeThe role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for adult or pediatric high-grade (HG) patient groups. This study aims to illustrate whether surgical resection and adjuvant therapy provide survival benefits for patients with histologically confirmed BSG.Patients and MethodsThis retrospective cohort study included 529 patients with histologically confirmed BSG in Surveillance Epidemiology and End Results (SEER) database from 2006-2015. Patients were divided into four groups by age and World Health Organization (WHO) grade. Kaplan-Meier curves of CSS were plotted by different treatment options to compare the survival probability. Univariate and multivariable analyses were then conducted to determine the prognosis effects of surgical resection and adjuvant therapy on cancer specific survival (CSS). All analyses were done in four different groups separately.ResultsThe final sample included 529 patients. The entire study population was divided into groups of pediatric LG (n=236, 44.6%), pediatric HG (n=37, 7.0%), adult LG (n=204, 38.6%) and adult HG (n=52, 9.8%). 52.7% (n=144) of pediatric patients had pilocytic astrocytoma and 45.3% (n=116) of adult patients had ependymoma. Pediatric LGBSG group had the highest gross total resection (GTR) rate (61.4%) and 5-year CSS rate (88.6%). Kaplan-Meier curves of pediatric LGBSG group revealed that patients treated with GTR had significantly better survival probability (P=0.033). Multivariable analysis identified GTR as independently significant predictor for prolonged CSS in pediatric LGBSG group (HR0.29, 95%CI 0.11-0.78, P=0.015); Surgical resection showed no relation to CSS in other patient groups. Kaplan-Meier curves of adult HGBSG group showed that patients treated with both RT and CT in adult HGBSG group had the best survival probability (P=0.02). However, multivariable analysis showed the combination of radiotherapy (RT) and chemotherapy (CT) was not significantly related to better CSS in adult HGBSG group (HR0.35, 95%CI 0.11-1.09, P=0.070). Adjuvant therapy didn’t associate with better CSS in other patient groups.ConclusionPediatric LGBSG group had the highest GTR rate and the most favorable clinical outcome. GTR can provide significant survival benefits for pediatric LGBSG group.
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spelling doaj.art-93c7466e6bbd451f91d434e41c8626f32022-12-21T21:55:12ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-03-011110.3389/fonc.2021.566972566972The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem GliomaZhuoyi Liu0Zhuoyi Liu1Zhuoyi Liu2Songshan Feng3Songshan Feng4Songshan Feng5Jing Li6Hui Cao7Jun Huang8Jun Huang9Fan Fan10Fan Fan11Fan Fan12Li Cheng13Zhixiong Liu14Zhixiong Liu15Quan Cheng16Quan Cheng17Quan Cheng18Department of Anesthesiology, Xiangya Hospital, Center South University, Changsha, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaXiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, ChinaKey Laboratory of Molecular Radiation Oncology of Hunan Province, Changsha, ChinaDepartment of Rehabilitation, Second Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Psychiatry, The Second People's Hospital of Hunan Province, The Hospital of Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, ChinaCenter for Medical Genetics & Hunan Provincial Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, ChinaDepartment of Emergency, Fengyang County Hospital of Traditional Chinese Medicine, Fengyang, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, ChinaDepartment of Neurosurgery, Xiangya Hospital, Center South University, Changsha, ChinaNational Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China0Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, ChinaPurposeThe role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for adult or pediatric high-grade (HG) patient groups. This study aims to illustrate whether surgical resection and adjuvant therapy provide survival benefits for patients with histologically confirmed BSG.Patients and MethodsThis retrospective cohort study included 529 patients with histologically confirmed BSG in Surveillance Epidemiology and End Results (SEER) database from 2006-2015. Patients were divided into four groups by age and World Health Organization (WHO) grade. Kaplan-Meier curves of CSS were plotted by different treatment options to compare the survival probability. Univariate and multivariable analyses were then conducted to determine the prognosis effects of surgical resection and adjuvant therapy on cancer specific survival (CSS). All analyses were done in four different groups separately.ResultsThe final sample included 529 patients. The entire study population was divided into groups of pediatric LG (n=236, 44.6%), pediatric HG (n=37, 7.0%), adult LG (n=204, 38.6%) and adult HG (n=52, 9.8%). 52.7% (n=144) of pediatric patients had pilocytic astrocytoma and 45.3% (n=116) of adult patients had ependymoma. Pediatric LGBSG group had the highest gross total resection (GTR) rate (61.4%) and 5-year CSS rate (88.6%). Kaplan-Meier curves of pediatric LGBSG group revealed that patients treated with GTR had significantly better survival probability (P=0.033). Multivariable analysis identified GTR as independently significant predictor for prolonged CSS in pediatric LGBSG group (HR0.29, 95%CI 0.11-0.78, P=0.015); Surgical resection showed no relation to CSS in other patient groups. Kaplan-Meier curves of adult HGBSG group showed that patients treated with both RT and CT in adult HGBSG group had the best survival probability (P=0.02). However, multivariable analysis showed the combination of radiotherapy (RT) and chemotherapy (CT) was not significantly related to better CSS in adult HGBSG group (HR0.35, 95%CI 0.11-1.09, P=0.070). Adjuvant therapy didn’t associate with better CSS in other patient groups.ConclusionPediatric LGBSG group had the highest GTR rate and the most favorable clinical outcome. GTR can provide significant survival benefits for pediatric LGBSG group.https://www.frontiersin.org/articles/10.3389/fonc.2021.566972/fullbrainstem gliomaSEERadjuvant therapygross total resectioncancer specific survival
spellingShingle Zhuoyi Liu
Zhuoyi Liu
Zhuoyi Liu
Songshan Feng
Songshan Feng
Songshan Feng
Jing Li
Hui Cao
Jun Huang
Jun Huang
Fan Fan
Fan Fan
Fan Fan
Li Cheng
Zhixiong Liu
Zhixiong Liu
Quan Cheng
Quan Cheng
Quan Cheng
The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
Frontiers in Oncology
brainstem glioma
SEER
adjuvant therapy
gross total resection
cancer specific survival
title The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
title_full The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
title_fullStr The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
title_full_unstemmed The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
title_short The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma
title_sort survival benefits of surgical resection and adjuvant therapy for patients with brainstem glioma
topic brainstem glioma
SEER
adjuvant therapy
gross total resection
cancer specific survival
url https://www.frontiersin.org/articles/10.3389/fonc.2021.566972/full
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