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Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study

BACKGROUND: The survival benefit of re-resection for glioblastoma (GBM) remains controversial, owing to the immortal time bias inadequately considered in many studies where re-resection was treated as a fixed, rather than a time-dependent factor. Using the Surveillance, Epidemiology, and End Results...

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Autores principales: Goldman, Debra A, Reiner, Anne S, Diamond, Eli L, DeAngelis, Lisa M, Tabar, Viviane, Panageas, Katherine S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813163/
https://www.ncbi.nlm.nih.gov/pubmed/33506202
http://dx.doi.org/10.1093/noajnl/vdaa159
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author Goldman, Debra A
Reiner, Anne S
Diamond, Eli L
DeAngelis, Lisa M
Tabar, Viviane
Panageas, Katherine S
author_facet Goldman, Debra A
Reiner, Anne S
Diamond, Eli L
DeAngelis, Lisa M
Tabar, Viviane
Panageas, Katherine S
author_sort Goldman, Debra A
collection PubMed
description BACKGROUND: The survival benefit of re-resection for glioblastoma (GBM) remains controversial, owing to the immortal time bias inadequately considered in many studies where re-resection was treated as a fixed, rather than a time-dependent factor. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we assessed treatment patterns for older adults and evaluated the association between re-resection and overall survival (OS), accounting for the timing of re-resection. METHODS: This retrospective cohort study included elderly patients (age ≥66) in the SEER-Medicare linked database diagnosed with GBM between 2006 and 2015 who underwent initial resection. Time-dependent Cox regression was used to assess the association between re-resection and OS, controlling for age, gender, race, poverty level, geographic region, marital status, comorbidities, receipt of radiation + temozolomide, and surgical complications. RESULTS: Our analysis included 3604 patients with median age 74 (range: 66–96); 54% were men and 94% were white. After initial resection, 44% received radiation + temozolomide and these patients had a lower hazard of death (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.26–0.31, P < .001). In total, 9.5% (n = 343) underwent re-resection. In multivariable analyses, no survival benefit was seen for patients who underwent re-resection (HR: 1.12, 95% CI: 0.99–1.27, P = .07). CONCLUSIONS: Re-resection rates were low among elderly GBM patients, and no survival advantage was observed for patients who underwent re-resection. However, patients who received standard of care at initial diagnosis had a lower risk of death. Older adults benefit from receiving radiation + temozolomide after initial resection, and future studies should assess the relationship between re-resection and OS taking the time of re-resection into account.
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spelling pubmed-78131632021-01-26 Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study Goldman, Debra A Reiner, Anne S Diamond, Eli L DeAngelis, Lisa M Tabar, Viviane Panageas, Katherine S Neurooncol Adv Clinical Investigations BACKGROUND: The survival benefit of re-resection for glioblastoma (GBM) remains controversial, owing to the immortal time bias inadequately considered in many studies where re-resection was treated as a fixed, rather than a time-dependent factor. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we assessed treatment patterns for older adults and evaluated the association between re-resection and overall survival (OS), accounting for the timing of re-resection. METHODS: This retrospective cohort study included elderly patients (age ≥66) in the SEER-Medicare linked database diagnosed with GBM between 2006 and 2015 who underwent initial resection. Time-dependent Cox regression was used to assess the association between re-resection and OS, controlling for age, gender, race, poverty level, geographic region, marital status, comorbidities, receipt of radiation + temozolomide, and surgical complications. RESULTS: Our analysis included 3604 patients with median age 74 (range: 66–96); 54% were men and 94% were white. After initial resection, 44% received radiation + temozolomide and these patients had a lower hazard of death (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.26–0.31, P < .001). In total, 9.5% (n = 343) underwent re-resection. In multivariable analyses, no survival benefit was seen for patients who underwent re-resection (HR: 1.12, 95% CI: 0.99–1.27, P = .07). CONCLUSIONS: Re-resection rates were low among elderly GBM patients, and no survival advantage was observed for patients who underwent re-resection. However, patients who received standard of care at initial diagnosis had a lower risk of death. Older adults benefit from receiving radiation + temozolomide after initial resection, and future studies should assess the relationship between re-resection and OS taking the time of re-resection into account. Oxford University Press 2020-11-29 /pmc/articles/PMC7813163/ /pubmed/33506202 http://dx.doi.org/10.1093/noajnl/vdaa159 Text en © The Author(s) 2020. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology. http://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Investigations
Goldman, Debra A
Reiner, Anne S
Diamond, Eli L
DeAngelis, Lisa M
Tabar, Viviane
Panageas, Katherine S
Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title_full Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title_fullStr Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title_full_unstemmed Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title_short Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study
title_sort lack of survival advantage among re-resected elderly glioblastoma patients: a seer-medicare study
topic Clinical Investigations
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813163/
https://www.ncbi.nlm.nih.gov/pubmed/33506202
http://dx.doi.org/10.1093/noajnl/vdaa159
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