Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

Ermani, Mario; Gardini, Giorgio; Lanza, Giovanni; Silini, Enrico Maria; Cavuto, Silvio; Baruzzi, Agostino; Albani, Fiorenzo; Calbucci, Fabio; D’Alessandro, Roberto; Michelucci, Roberto; Brandes, Alba Ariela; Eusebi, Vincenzo; Ceruti, Samuele; Fainardi, Enrico; Tamarozzi, Riccardo; Emiliani, E; Cavallo, Michele Alessandro; Franceschi, Enrico; Tosoni, Alicia; Fiorica, Francesco; Valentini, A.; Depenni, Roberta; Mucciarini, Claudia; Crisi, Girolamo; Sasso, E.H.; Biasini, Claudia; Cavanna, Luigi; Guidetti, Denise A.; Marcello, Norina; Pisanello, Anna; Cremonini, Anna Maria; Guiducci, Graziano; Pasqua, Silvia De; Testoni, S.; Agati, R.; Ambrosetto, G.; Bacci, A.; Baldin, Elisa; Baldrati, A.; Barbieri, Erika; Bartolini, Stefania; Bellavista, E.; Bisulli, Francesca; Bonora, Elena; Bunkheila, Feisal; Carelli, V.; Crisci, Mario; Dall'Occa, P.; Biase, Dario de; Ferro, Salvatore; Franceschi, C.; Frezza, G.; Grasso, Vincenzo; Leonardi, Marco; Marucci, Gianluca; Mazzocchi, V.; Morandi, Luca; Mostacci, Barbara; Palandri, Giorgio; Pasini, Eva; Trossello, Marco Pastore; Pession, Annalisa; Ragazzi, Moira; Riguzzi, P.; Rinaldi, Roberta; Rizzi, Silvia; Romeo, Giovanni; Spagnolli, F.; Tinuper, Paolo; Trocino, C.; Cerasoli, Serenella; Dall’Agata, Monia; Faedi, Marina; Frattarelli, Massimo; Gentili, G.; Giovannini, Andrea; Iorio, Paolo; Pasquini, U.; Galletti, Giuseppe; Guidi, Claretta; Neri, Walter; Patuelli, A.; Strumia, Silvia; Casmiro, Mario; Gamboni, Alessandro; Rasi, F.; Cruciani, Giorgio; Cenni, P.; Dazzi, Claudio; Guidi, AR; Zumaglini, F.; Amadori, Alberto; Pasini, Elena; Pasquinelli, Mary; Pasquini, E.; Polselli, A.; Ravasio, Alessandro; Viti, Beatrice; Sintini, M.; Ariatti, Alessandra; Bertolini, Federica; Bigliardi, Guido; Carpeggiani, P.; Cavalleri, Francesca; Meletti, Stefano; Nichelli, Paolo Frigio; Pettorelli, Elisa; Pinna, Giampietro; Zunarelli, Elena; Artioli, Fabrizio; Bernardini, Ilaria; Costa, Matias; GRECO, GIOVANNI LO; Guerzoni, R.; Stucchi, C.; Iaccarino, Corrado; Rizzi, Romana; Zuccoli, Giulio; Api, P.; Cartei, F.; Fallica, Elisa; Granieri, Enrico; Latini, Francesco; Lelli, Gary Joseph; Monetti, C; Ramponi, Vania; Saletti, Andrea; Schivalocchi, Roberta; Seraceni, Silva; Tola, Maria Rosaria; Urbini, Benedetta; Giorgi, Carlotta; Montanari, Emanuele; Cerasti, Davide; Crafa, Pellegrino; Dascola, Isabella; Florindo, Irene; Mazza, Stefano; Servadei, Franco; Em, Silini; Torelli, Paola; Immovilli, Paolo; Morelli, Nicola; Vanzo, C.

doi:10.1093/nop/npu021

Cited by 26 publications

(19 citation statements)

References 20 publications

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“…Some previous papers have summarized the first-line treatment in population studies. For example, after surgery in the works of Graus et al [ 32 ], Brandes et al [ 33 ], and in our series, 57%/62.5%/59.9% of all patients received the combined RT–temozolomide treatment, 21%/15.7%/20.1% received other regimens, and 22%/21.7%/20% were not treated, respectively. But, to our knowledge, only one recent paper described the detail and outcome of the different phases of the standard protocol in a large population-based study, and according to the surgery [ 30 ].…”

Section: Discussionsupporting

confidence: 53%

Association of patterns of care, prognostic factors, and use of radiotherapy–temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

et al. 2018

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Background Glioblastoma is the most frequent primary malignant brain tumor. In daily practice and at whole country level, oncological care management for glioblastoma patients is not completely known. Objectives To describe oncological patterns of care, prognostic factors, and survival for all patients in France with newly-diagnosed and histologically confirmed glioblastoma, and evaluate the impact of extended temozolomide use at the population level. Methods Nationwide population-based cohort study including all patients with newly-diagnosed and histologically confirmed glioblastoma in France in 2008 and followed until 2015. Results Data from 2053 glioblastoma patients were analyzed (male/female ratio 1.5, median age 64 years). Median overall survival (OS) was 11.2 [95% confidence interval (CI) 10.7–11.9] months. The first-line therapy and corresponding median survival (MS, in months) were: 13% did not receive any oncological treatment (biopsy only) (MS = 1.8, 95% CI 1.6–2.1), 27% received treatment without the combination of radiotherapy (RT)–temozolomide (MS = 5.9, 95% CI 5.5–6.6), 60% received treatment including the initiation of the concomitant phase of RT–temozolomide (MS = 16.4, 95% CI 15.2–17.4) whom 44% of patients initiated the temozolomide adjuvant phase (MS = 18.9, 95% CI 18.0–19.8). Only 22% patients received 6 cycles or more of adjuvant temozolomide (MS = 25.5, 95% CI 24.0–28.3). The multivariate analysis showed that the risk of mortality was significantly higher for the non-progressive patients who stopped at 6 cycles (standard protocol) than those who continued the treatment, hazard ratio = 1.5 (95% CI 1.2–1.9). Conclusion In non-progressive patients, prolonging the adjuvant temozolomide beyond 6 cycles may improve OS. Electronic supplementary material The online version of this article (10.1007/s11060-018-03065-z) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 53%

Association of patterns of care, prognostic factors, and use of radiotherapy–temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

et al. 2018

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“…In addition, although the majority of patients received TMZ as first‐line therapy in the modern era, none of the patients in the former study received any type of chemotherapy. A beneficial effect of the introduction of TMZ has been postulated in other population‐based studies from Norway, the United States, Spain, the United Kingdom, Sweden, and Italy . Importantly, all comparisons of the data from the current study with the historical cohort were limited by the inclusion of many patients (20%) diagnosed by neuroimaging alone from 1980 to 1994.…”

Section: Discussionmentioning

confidence: 76%

“…A beneficial effect of the introduction of TMZ has been postulated in other population-based studies from Norway, 14 the United States, 15,16 Spain, 17 the United Kingdom, 18 Sweden, 19 and Italy. 20 Importantly, all comparisons of the data from the current study with the historical cohort were limited by the inclusion of many patients (20%) diagnosed by neuroimaging alone from 1980 to 1994.…”

Section: Patterns Of Care For Primary Glioblastoma Per Year Of Diagnomentioning

confidence: 99%

Glioblastoma in the Canton of Zurich, Switzerland revisited: 2005 to 2009

Gramatzki

Dehler

Rushing

et al. 2016

Cancer

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BACKGROUND A population‐based analysis of patients with glioma diagnosed between 1980 and 1994 in the Canton of Zurich in Switzerland confirmed the overall poor prognosis of glioblastoma. To explore changes in outcome, registry data were reevaluated for patients diagnosed between 2005 and 2009. METHODS Patients with glioblastoma who were diagnosed between 2005 and 2009 were identified by the Zurich and Zug Cancer Registry. The prognostic significance of epidemiological and clinical data, isocitrate dehydrogenase 1 (IDH1)R132H mutation status, and O6 methylguanine DNA methyltransferase (MGMT) promoter methylation status was analyzed using the Kaplan‐Meier method and the Cox proportional hazards model. RESULTS A total of 264 patients with glioblastoma were identified, for an annual incidence of 3.9 compared with the previous incidence of 3.7. The mean age of the patients at the time of diagnosis was 59.5 years in the current cohort compared with 61.3 years previously. The overall survival (OS) rate was 46.4% at 1 year, 22.5% at 2 years, and 14.4% at 3 years in the current study compared with 17.7% at 1 year, 3.3% at 2 years, and 1.2% at 3 years as reported previously. The median OS for all patients with glioblastoma was 11.5 months compared with 4.9 months in the former patient population. The median OS was 1.9 months for best supportive care, 6.2 months for radiotherapy alone, 6.7 months for temozolomide alone, and 17.0 months for radiotherapy plus temozolomide. Multivariate analysis revealed age, Karnofsky performance score, extent of tumor resection, first‐line treatment, year of diagnosis, and MGMT promoter methylation status were associated with survival in patients with IDH1R132H‐nonmutant glioblastoma. CONCLUSIONS The OS of patients newly diagnosed with glioblastoma in the Canton of Zurich in Switzerland markedly improved from 1980 through 1994 to 2005 through 2009. Cancer 2016;122:2206–15. © 2016 American Cancer Society.

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“…Earlier reports have identified an association between larger case volumes and more favorable outcome after glioblastoma surgery [ 41 , 42 , 47 ] and after other cancer-related surgery [ 48 , 49 ]. In our findings, larger case volume is not associated with overall survival when adjusted for patient-related risk factors.…”

Section: Discussionmentioning

confidence: 99%

Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery

Hamer

Zwinderman

et al. 2019

J Neurooncol

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Purpose Standards for surgical decisions are unavailable, hence treatment decisions can be personalized, but also introduce variation in treatment and outcome. National registrations seek to monitor healthcare quality. The goal of the study is to measure between-hospital variation in risk-standardized survival outcome after glioblastoma surgery and to explore the association between survival and hospital characteristics in conjunction with patient-related risk factors. Methods Data of 2,409 adults with first-time glioblastoma surgery at 14 hospitals were obtained from a comprehensive, prospective population-based Quality Registry Neuro Surgery in The Netherlands between 2011 and 2014. We compared the observed survival with patient-specific risk-standardized expected early (30-day) mortality and late (2-year) survival, based on age, performance, and treatment year. We analyzed funnel plots, logistic regression and proportional hazards models. Results Overall 30-day mortality was 5.2% and overall 2-year survival was 13.5%. Median survival varied between 4.8 and 14.9 months among hospitals, and biopsy percentages ranged between 16 and 73%. One hospital had lower than expected early mortality, and four hospitals had lower than expected late survival. Higher case volume was related with lower early mortality (P = 0.031). Patient-related risk factors (lower age; better performance; more recent years of treatment) were significantly associated with longer overall survival. Of the hospital characteristics, longer overall survival was associated with lower biopsy percentage (HR 2.09, 1.34–3.26, P = 0.001), and not with academic setting, nor with case volume. Conclusions Hospitals vary more in late survival than early mortality after glioblastoma surgery. Widely varying biopsy percentages indicate treatment variation. Patient-related factors have a stronger association with overall survival than hospital-related factors. Electronic supplementary material The online version of this article (10.1007/s11060-019-03229-5) contains supplementary material, which is available to authorized users.

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Pattern of care and effectiveness of treatment for glioblastoma patients in the real world: Results from a prospective population-based registry. Could survival differ in a high-volume center?

Cited by 26 publications

References 20 publications

Association of patterns of care, prognostic factors, and use of radiotherapy–temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

Association of patterns of care, prognostic factors, and use of radiotherapy–temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study

Glioblastoma in the Canton of Zurich, Switzerland revisited: 2005 to 2009

Between-hospital variation in mortality and survival after glioblastoma surgery in the Dutch Quality Registry for Neuro Surgery

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