Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study

Sonabend, Adam M.; Zacharia, Brad E.; Cloney, Michael; Sonabend, Aarón; Showers, Christopher; Ebiana, Victoria; Nazarian, Matthew; Swanson, Kristin R.; Baldock, Anne; Brem, Henry; Bruce, Jeffrey N.; Butler, William E.; Cahill, Daniel P.; Carter, Bob S.; Orringer, Daniel A.; Roberts, David W.; Sagher, Oren; Sanai, Nader; Schwartz, Theodore H.; Silbergeld, Daniel L.; Sisti, Michael B.; Thompson, Reid C.; Waziri, Allen; McKhann, Guy M.

doi:10.1227/neu.0000000000001374

Cited by 36 publications

(29 citation statements)

References 49 publications

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“…Indeed, results of surveys on surgeons’ surgical plans correlates much more strongly with extent of resection than known predictive variables and clinical scales [47], suggesting that the decision-making process is incompletely captured with standard analyses such as ours. Moreover, Orringer et al found 28.3% disagreement between academic tumor surgeons about the feasibility of gross total resection for given lesions, suggesting that further highlighting the complexity of the decision and its inability to be reduced to simple binary variables [48].…”

Section: Discussionmentioning

confidence: 99%

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

et al. 2017

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Object Surgical resection is not the standard of care for primary central nervous system lymphoma (PCNSL), as historical studies have demonstrated unfavorable complication rates and limited benefits. Some recent studies suggest that resection may provide a therapeutic benefit, yet the safety of these procedures has not been systematically investigated in the setting of modern neurosurgery. We examined the safety of surgical resection for PCNSL. Methods We retrospectively analyzed all patients with PCNSL treated at Columbia University Medical Center between 2000 and 2015 to assess complications rates following biopsy or resection using the Glioma Outcomes Project system. We identified predictors of complications and selection for resection. Well-validated scales were used to quantify patients’ baseline clinical characteristics, including functional status, comorbid disease burden, and cardiac risk. Results The overall complication rate was 17.2% after resection, and 28.2% after biopsy. Cardiac risk (p = 0.047, OR 1.72 [1.01, 2.95]), and comorbid diagnoses (p = 0.004, OR 3.05 [1.42, 6.57]) predicted complications on multivariable regression. Patients who underwent resection had better KPS scores (median 70 v. 80, p = 0.0068, Δ 10 [0.0, 10.00]), and were less likely to have multiple (46.5% v. 27.6%, p = 0.030, OR 1.42 [1.05, 1.92]) or deep lesions (70.4% v. 39.7%, p = 0.001, OR 1.83 [1.26, 2.65]). Age (p = 0.048, OR 0.75 per 10-year increase [0.56, 1.00]) and deep lesions (p = 0.003, OR 0.29 [0.13, 0.65]) influenced selection for resection on multivariable regression. Conclusions Surgical resection of PCNSL is safe for select patients, with complication rates comparable to rates for other intracranial neoplasms. Whether there is a clinical benefit to resection cannot be concluded.

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Section: Discussionmentioning

confidence: 99%

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

et al. 2017

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“…which may serve as confounders when comparing the PCNSL cohort to the non-PCNSL cohort. Finally, as is the case with all brain tumors, determining the resectability of the tumor in PCNSL is a crucial step in the decision making process and should be part of the consideration when deciding between craniotomy versus biopsy ( 25 ).…”

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confidence: 99%

Assessing the Safety of Craniotomy for Resection of Primary Central Nervous System Lymphoma: A Nationwide Inpatient Sample Analysis

Yun

Yang²,

Cloney

et al. 2017

Front. Neurol.

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BackgroundUnlike many other central nervous system (CNS) tumors, the surgical management of primary central nervous system lymphomas (PCNSL) is traditionally limited by diagnostic biopsy. Studies that predate the use of modern neurosurgical techniques have reported a prohibitive operative morbidity for this surgery. These early experiences have dictated the non-surgical management of PCNSL, whereas resection for cytoreduction is a mainstay of treatment in other CNS malignancies. Recent studies have suggested that craniotomy with the goal of cytoreduction might be associated with a favorable overall and progression-free survival for some patients with PCNSL. To challenge the traditional non-surgical paradigm, it is essential to first investigate the safety of resection for PCNSL.MethodsTo determine the operative morbidity of resection for this disease, we performed a population-based assessment of complications using the nationwide inpatient sample database for the years 1998–2013 for biopsies and open craniotomies for PCNSL and other brain tumors.ResultsAmong 95 patients who underwent biopsy and 34 patients who underwent craniotomy, we found no significant difference in complication rates between craniotomy for resection and biopsy procedures for PCNSL (23.16 versus 20.59%). The types of complications differ between diagnoses, with the PCNSL cohort suffering mainly medical complications and the non-PCNSL cohort suffering mainly from neurological complications.ConclusionThese findings support the safety of craniotomies in PCNSL and help provide a rationale for future prospective studies to evaluate the safety and efficacy of resection for this disease.

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“…Much of this information is included in the web card, and is indexed by the Lucene/Solr search engine. Therefore, searching MalaCards provides users with direct access to dozens of disease information sources in one go, akin to crowd wisdom (29). The MalaCards search provides a default set of section weights.…”

Section: Search and Navigationmentioning

confidence: 99%

MalaCards: an amalgamated human disease compendium with diverse clinical and genetic annotation and structured search

et al. 2016

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The MalaCards human disease database (http://www.malacards.org/) is an integrated compendium of annotated diseases mined from 68 data sources. MalaCards has a web card for each of ∼20 000 disease entries, in six global categories. It portrays a broad array of annotation topics in 15 sections, including Summaries, Symptoms, Anatomical Context, Drugs, Genetic Tests, Variations and Publications. The Aliases and Classifications section reflects an algorithm for disease name integration across often-conflicting sources, providing effective annotation consolidation. A central feature is a balanced Genes section, with scores reflecting the strength of disease-gene associations. This is accompanied by other gene-related disease information such as pathways, mouse phenotypes and GO-terms, stemming from MalaCards’ affiliation with the GeneCards Suite of databases. MalaCards’ capacity to inter-link information from complementary sources, along with its elaborate search function, relational database infrastructure and convenient data dumps, allows it to tackle its rich disease annotation landscape, and facilitates systems analyses and genome sequence interpretation. MalaCards adopts a ‘flat’ disease-card approach, but each card is mapped to popular hierarchical ontologies (e.g. International Classification of Diseases, Human Phenotype Ontology and Unified Medical Language System) and also contains information about multi-level relations among diseases, thereby providing an optimal tool for disease representation and scrutiny.

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Defining Glioblastoma Resectability Through the Wisdom of the Crowd: A Proof-of-Principle Study

Abstract: In this pilot study, we demonstrate the feasibility of measuring the resectability of glioblastoma through crowdsourcing. This tool could be used to quantify resectability, a potential confounder in neuro-oncology clinical trials.

Cited by 36 publications

References 49 publications

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

The safety of resection for primary central nervous system lymphoma: a single institution retrospective analysis

Assessing the Safety of Craniotomy for Resection of Primary Central Nervous System Lymphoma: A Nationwide Inpatient Sample Analysis

MalaCards: an amalgamated human disease compendium with diverse clinical and genetic annotation and structured search

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