KEY TAKEAWAYS
- The study aimed to evaluate the impact of pre-resection biopsy on patients with surgically-accessible GBM.
- The results showed that pre-operative biopsies for surgically accessible GBM are linked to poorer survival compared to upfront resection.
Aggressive resection in surgically-accessible glioblastoma (GBM) is associated with better survival outcomes than less extensive resections. However, the clinical significance of conducting a biopsy prior to definitive resection has not been previously assessed in brain cancer.
Ping Zhu and the team conducted a study that aimed to assess the clinical significance of pre-resection biopsy in surgically-accessible GBM regarding survival outcomes.
The study analyzed data from 17,334 patients diagnosed with GBM between 2010 and 2014, obtained from the NCDB. Patients were divided into two groups: “upfront resection” and “biopsy followed by resection”.
The key outcomes assessed included overall survival (OS), 30-day readmission/mortality, 90-day mortality, and length of hospital stay (LOS). Survival analysis was conducted using Kaplan-Meier methods and accelerated failure time (AFT) models. Multivariable binary logistic regression was utilized to compare differences between groups. Multiple imputation and propensity score matching (PSM) were employed for validation purposes.
The results demonstrated that “upfront resection” yielded superior OS compared to “biopsy followed by resection” (median OS: 12.4 versus 11.1 months, log-rank p = 0.001). Similarly, multivariable accelerated failure time (AFT) models favored “upfront resection” (time ratio [TR]: 0.83, 95% CI: 0.75–0.93, P= 0.001).
Among patients undergoing “upfront gross-total resection (GTR)”, higher OS was observed compared to those undergoing “upfront subtotal resection (STR)”, “GTR following STR”, and “GTR or STR following initial biopsy” (median OS: 14.4 vs. 10.3, 13.5, 13.3, and 9.1 months; TR: 1.00 [Ref.], 0.75, 0.82, 0.88, and 0.67).
Factors associated with a higher likelihood of undergoing upfront resection included recent years of diagnosis, higher income, facilities located in Southern regions, and treatment at academic facilities. Multivariable regression analysis revealed decreased 30 and 90-day mortality rates for patients undergoing “upfront resection”, with reductions of 73% and 44%, respectively (P< 0.001).
The study concluded that pre-operative biopsies for surgically accessible GBM are linked to poorer survival outcomes, even after subsequent resection, when compared to patients undergoing upfront resection. No funding was provided.
Source: https://link.springer.com/article/10.1007/s11060-024-04644-z
Zhu, P., Pichardo-Rojas, P.S., Dono, A. et al. (2024) “The detrimental effect of biopsy preceding resection in surgically accessible glioblastoma: results from the national cancer database.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04644-z.
