Extent of resection and survival for oligodendroglioma: a U.S. population-based study

Connor J. Kinslow; Andrew L.A. Garton; Ali I. Rae; Logan P. Marcus; Christopher M. Adams; Guy M. McKhann; Michael B. Sisti; E. Sander Connolly; Jeffrey N. Bruce; Alfred I. Neugut; Adam M. Sonabend; Peter Canoll; Simon K. Cheng; Tony J.C. Wang

doi:10.1007/s11060-019-03261-5

Extent of resection and survival for oligodendroglioma: a U.S. population-based study

Connor J. Kinslow, Andrew L.A. Garton, Ali I. Rae, Logan P. Marcus, Christopher M. Adams, Guy M. McKhann, Michael B. Sisti, E. Sander Connolly, Jeffrey N. Bruce, Alfred I. Neugut, Adam M. Sonabend, Peter Canoll, Simon K. Cheng, Tony J.C. Wang^*

^*Corresponding author for this work

Neurological Surgery

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results. Objective: To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. population. Methods: Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets. Results: 3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68–0.97] and HR 0.65 [0.54–0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58–0.95], HR 0.60 [0.44–0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors. Conclusion: Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.

Original language	English (US)
Pages (from-to)	591-601
Number of pages	11
Journal	Journal of Neuro-Oncology
Volume	144
Issue number	3
DOIs	https://doi.org/10.1007/s11060-019-03261-5
State	Published - Sep 1 2019

Keywords

Extent of resection
Gross-total resection
Oligodendroglioma
Surgery

ASJC Scopus subject areas

Oncology
Neurology
Clinical Neurology
Cancer Research

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Kinslow, C. J., Garton, A. L. A., Rae, A. I., Marcus, L. P., Adams, C. M., McKhann, G. M., Sisti, M. B., Connolly, E. S., Bruce, J. N., Neugut, A. I., Sonabend, A. M., Canoll, P., Cheng, S. K., & Wang, T. J. C. (2019). Extent of resection and survival for oligodendroglioma: a U.S. population-based study. Journal of Neuro-Oncology, 144(3), 591-601. https://doi.org/10.1007/s11060-019-03261-5

Kinslow, Connor J. ; Garton, Andrew L.A. ; Rae, Ali I. ; Marcus, Logan P. ; Adams, Christopher M. ; McKhann, Guy M. ; Sisti, Michael B. ; Connolly, E. Sander ; Bruce, Jeffrey N. ; Neugut, Alfred I. ; Sonabend, Adam M. ; Canoll, Peter ; Cheng, Simon K. ; Wang, Tony J.C. / Extent of resection and survival for oligodendroglioma : a U.S. population-based study. In: Journal of Neuro-Oncology. 2019 ; Vol. 144, No. 3. pp. 591-601.

@article{f2c11a96cb184f67a6272e9d9e2f8803,

title = "Extent of resection and survival for oligodendroglioma: a U.S. population-based study",

abstract = "Background: National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results. Objective: To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. population. Methods: Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets. Results: 3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68–0.97] and HR 0.65 [0.54–0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58–0.95], HR 0.60 [0.44–0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors. Conclusion: Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.",

keywords = "Extent of resection, Gross-total resection, Oligodendroglioma, Surgery",

author = "Kinslow, {Connor J.} and Garton, {Andrew L.A.} and Rae, {Ali I.} and Marcus, {Logan P.} and Adams, {Christopher M.} and McKhann, {Guy M.} and Sisti, {Michael B.} and Connolly, {E. Sander} and Bruce, {Jeffrey N.} and Neugut, {Alfred I.} and Sonabend, {Adam M.} and Peter Canoll and Cheng, {Simon K.} and Wang, {Tony J.C.}",

year = "2019",

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doi = "10.1007/s11060-019-03261-5",

language = "English (US)",

volume = "144",

pages = "591--601",

journal = "Journal of Neuro-Oncology",

issn = "0167-594X",

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Extent of resection and survival for oligodendroglioma : a U.S. population-based study. / Kinslow, Connor J.; Garton, Andrew L.A.; Rae, Ali I.; Marcus, Logan P.; Adams, Christopher M.; McKhann, Guy M.; Sisti, Michael B.; Connolly, E. Sander; Bruce, Jeffrey N.; Neugut, Alfred I.; Sonabend, Adam M.; Canoll, Peter; Cheng, Simon K.; Wang, Tony J.C.

In: Journal of Neuro-Oncology, Vol. 144, No. 3, 01.09.2019, p. 591-601.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Extent of resection and survival for oligodendroglioma

T2 - a U.S. population-based study

AU - Kinslow, Connor J.

AU - Garton, Andrew L.A.

AU - Rae, Ali I.

AU - Marcus, Logan P.

AU - Adams, Christopher M.

AU - McKhann, Guy M.

AU - Sisti, Michael B.

AU - Connolly, E. Sander

AU - Bruce, Jeffrey N.

AU - Neugut, Alfred I.

AU - Sonabend, Adam M.

AU - Canoll, Peter

AU - Cheng, Simon K.

AU - Wang, Tony J.C.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background: National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results. Objective: To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. population. Methods: Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets. Results: 3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68–0.97] and HR 0.65 [0.54–0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58–0.95], HR 0.60 [0.44–0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors. Conclusion: Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.

AB - Background: National guidelines recommend maximal safe resection of low-grade and high-grade oligodendrogliomas. However, there is no level 1 evidence to support these guidelines, and recent retrospective studies on the topic have yielded mixed results. Objective: To assess the association between extent of resection (EOR) and survival for oligodendrogliomas in the general U.S. population. Methods: Cases diagnosed between 2004 and 2013 were selected from the Surveillance, Epidemiology, and End-Results (SEER) Program and retrospectively analyzed for treatment, prognostic factors, and survival times. Cases that did not undergo tumor de-bulking surgery (e.g. no surgery or biopsy alone) were compared to subtotal resection (resection) and gross-total resection (GTR). The primary end-points were overall survival (OS) and cause-specific survival (CSS). An external validation cohort with 1p/19q-codeleted tumors was creating using the TCGA and GSE16011 datasets. Results: 3135 Cases were included in the final analysis. The 75% survival time (75ST) and 5-year survival rates were 47 months and 70.8%, respectively. Subtotal resection (STR, 75ST = 50 months) and GTR (75ST = 61 months) were associated with improved survival times compared to cases that did not undergo surgical debulking (75ST = 20 months, P < 0.001 for both), with reduced hazard ratios (HRs) after controlling for other factors (HR 0.81 [0.68–0.97] and HR 0.65 [0.54–0.79], respectively). GTR was associated with improved OS in both low-grade and anaplastic oligodendroglioma subgroups (HR 0.74 [0.58–0.95], HR 0.60 [0.44–0.82], respectively) while STR fell short of significance in the subgroup analysis. All findings were corroborated by multivariable analysis of CSS and externally validated in a cohort of patients with 1p19q-codeleted tumors. Conclusion: Greater EOR is associated with improved survival in oligodendrogliomas. Our findings in this U.S. population-based cohort support national guidelines.

KW - Extent of resection

KW - Gross-total resection

KW - Oligodendroglioma

KW - Surgery

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