Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

Han, Qinghong; Liang, Hengpo; Pan, Cheng; Yang, Haizhen; Zhao, Pingfan

doi:10.3389/fonc.2020.00151

Cited by 45 publications

(38 citation statements)

References 46 publications

(45 reference statements)

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“…In particular, the ≥65 years patient cohort had higher rates of both major and minor complications and prolonged LOS than those reported in prior studies, which used results showing lower rates of poor outcome compared to the present study to conclude that tumor resection in older patient populations is safe in carefully selected patients. [ 16 , 18 , 19 ] Our results reinforce the need for careful consideration and preoperative optimization of medical comorbidities and other risk factors more prevalent among older patients. [ 2 , 33 ] It is also notable that many of these prior studies were conducted on patients with glioblastoma alone.…”

Section: Discussionsupporting

confidence: 63%

“…[ 4 , 10 ] However, most studies suggest that intra-axial tumor resection in older patients is safe in well-selected patients. [ 16 , 18 , 19 ] Similarly, age has been correlated with poorer outcomes in meningiomas in the absence of careful consideration of preoperative medical risk factors that may disproportionally affect older patient populations. [ 6 , 9 , 11 , 13 , 21 , 23 , 29 ] Several case series have reported age as an important prognostic factor for infratentorial tumor outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

Perla

Pertsch

Leary

et al. 2021

Surgical Neurology International

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Background: Poorer outcomes for infratentorial tumor resection have been reported. There is a lack of large multicenter analyses describing infratentorial surgery outcomes in older patients. We characterized outcomes in patients aged ≥65 years undergoing infratentorial cranial surgery. Methods: The National Surgical Quality Improvement Project database was queried from 2012 to 2018 for patients ≥18 years undergoing elective infratentorial cranial surgery for tumor resection. Patients were grouped into 65–74 years, ≥75 years, and 18–64 years cohorts. Multivariable regressions compared outcome measures. Results: Of 2212 patients, 28.3% were ≥65 years, of whom 24.8% were ≥75 years. Both older subpopulations had worse American Society of Anesthesiologists classification compared to controls (P < 0.01) and more comorbidities. Patients 65–74 and ≥75 years had higher rates of major complication (adjusted odds ratio [aOR] = 1.77, 95% CI = 1.13–2.79 and aOR = 3.44, 95% CI = 1.96–6.02, respectively), prolonged length of stay (LOS) (aOR = 1.89, 95% CI = 1.15–3.12 and aOR = 3.00, 95% CI = 1.65–5.44, respectively), and were more likely to be discharged to a location other than home (aOR = 2.43, 95% CI =1.73–3.4 and aOR = 3.41, 95% CI = 2.18–5.33, respectively) relative to controls. Patients ≥75 had higher rates of readmission (aOR = 1.86, 95% CI = 1.13–3.08) and mortality (aOR = 3.28, 95% CI = 1.21–8.89) at 30 days. Conclusion: Patients ≥65 years experienced more complications, prolonged LOS, and were less often discharged home than adults <65 years. Patients ≥75 years had higher rates of 30-day readmission and mortality. There is a need for careful preoperative optimization in older patients undergoing infratentorial tumor cranial surgery.

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Section: Discussionsupporting

confidence: 63%

Section: Introductionmentioning

confidence: 99%

Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

Perla

Pertsch

Leary

et al. 2021

Surgical Neurology International

View full text Add to dashboard Cite

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“…The survival data were further analyzed using a Cox proportional-hazard model, adjusted for factors that were known to influence the outcome of GBM patients such as age, Karnofsky Performance Scale (KPS), therapy, extent of surgical resection, MGMT methylation and IDH mutation status [ 19 , 20 , 21 , 22 ]. The proportional hazard assumption testing for Tctex1 showed a p -value of 0.515, indicating that the assumption of this model was satisfied.…”

Section: Resultsmentioning

confidence: 99%

Dynein Light Chain Protein Tctex1: A Novel Prognostic Marker and Molecular Mediator in Glioblastoma

Dumitru

Stelzer

Nocerino

et al. 2021

Cancers

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The purpose of this study was to determine the role of Tctex1 (DYNLT1, dynein light chain-1) in the pathophysiology of glioblastoma (GBM). To this end, we performed immunohistochemical analyses on tissues from GBM patients (n = 202). Tctex1 was additionally overexpressed in two different GBM cell lines, which were then evaluated in regard to their proliferative and invasive properties. We found that Tctex1 levels were significantly higher in GBM compared to healthy adjacent brain tissues. Furthermore, high Tctex1 expression was significantly associated with the short overall- (p = 0.002, log-rank) and progression-free (p = 0.028, log-rank) survival of GBM patients and was an independent predictor of poor overall survival in multivariate Cox-regression models. In vitro, Tctex1 promoted the metabolic activity, anchorage-independent growth and proliferation of GBM cells. This phenomenon was previously shown to occur via the phosphorylation of retinoblastoma protein (phospho-RB). Here, we found a direct and significant correlation between the levels of Tctex1 and phospho-RB (Ser807/801) in tissues from GBM patients (p = 0.007, Rho = 0.284, Spearman’s rank). Finally, Tctex1 enhanced the invasiveness of GBM cells and the release of pro-invasive matrix metalloprotease 2 (MMP2). These findings indicate that Tctex1 promotes GBM progression and therefore might be a useful therapeutic target in this type of cancer.

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“…In contrast, STR is defined as removal of a portion of the tumor and residual tumor lesions are observed in post-operative images. Based on the systematic reviews and meta-analyses conducted by Brown et al and Han et al, studies showed that GTR significantly improves progression-free survival (PFS) and overall survival for GBM patients in comparison to STR [ 11 , 12 ]. However, multiple tumor lesions, bilateral tumor involvement, and bulky tumors pose a clinical challenge and risk for total resection [ 13 ].…”

Section: Current Treatment For Glioblastoma Multiforme (Gbm)— Where We Are Now?mentioning

confidence: 99%

Glioblastoma Multiforme—A Look at the Past and a Glance at the Future

King

Benhabbour

2021

Pharmaceutics

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Gliomas are the most common type of brain tumor that occur in adults and children. Glioblastoma multiforme (GBM) is the most common, aggressive form of brain cancer in adults and is universally fatal. The current standard-of-care options for GBM include surgical resection, radiotherapy, and concomitant and/or adjuvant chemotherapy. One of the major challenges that impedes success of chemotherapy is the presence of the blood–brain barrier (BBB). Because of the tightly regulated BBB, immune surveillance in the central nervous system (CNS) is poor, contributing to unregulated glioma cell growth. This review gives a comprehensive overview of the latest advances in treatment of GBM with emphasis on the significant advances in immunotherapy and novel therapeutic delivery strategies to enhance treatment for GBM.

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Gross Total vs. Subtotal Resection on Survival Outcomes in Elderly Patients With High-Grade Glioma: A Systematic Review and Meta-Analysis

Cited by 45 publications

References 46 publications

Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

Outcomes of infratentorial cranial surgery for tumor resection in older patients: An analysis of the National Surgical Quality Improvement Program

Dynein Light Chain Protein Tctex1: A Novel Prognostic Marker and Molecular Mediator in Glioblastoma

Glioblastoma Multiforme—A Look at the Past and a Glance at the Future

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