Comparison of a Strategy Favoring Early Surgical Resection vs a Strategy Favoring Watchful Waiting in Low-Grade Gliomas
Top Cited Papers
Open Access
- 14 November 2012
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 308 (18), 1881-1888
- https://doi.org/10.1001/jama.2012.12807
Abstract
Context There are no controlled studies on surgical treatment of diffuse low-grade gliomas (LGGs), and management is controversial. Objective To examine survival in population-based parallel cohorts of LGGs from 2 Norwegian university hospitals with different surgical treatment strategies. Design, Setting, and Patients Both neurosurgical departments are exclusive providers in adjacent geographical regions with regional referral practices. In hospital A diagnostic biopsies followed by a “wait and scan” approach has been favored (biopsy and watchful waiting), while early resections have been advocated in hospital B (early resection). Thus, the treatment strategy in individual patients has been highly dependent on the patient's residential address. Histopathology specimens from all adult patients diagnosed with LGG from 1998 through 2009 underwent a blinded histopathological review to ensure uniform classification and inclusion. Follow-up ended April 11, 2011. There were 153 patients (66 from the center favoring biopsy and watchful waiting and 87 from the center favoring early resection) with diffuse LGGs included. Main Outcome Measure The prespecified primary end point was overall survival based on regional comparisons without adjusting for administered treatment. Results Initial biopsy alone was carried out in 47 (71%) patients served by the center favoring biopsy and watchful waiting and in 12 (14%) patients served by the center favoring early resection (P < .001). Median follow-up was 7.0 years (interquartile range, 4.5-10.9) at the center favoring biopsy and watchful waiting and 7.1 years (interquartile range, 4.2-9.9) at the center favoring early resection (P = .95). The 2 groups were comparable with respect to baseline parameters. Overall survival was significantly better with early surgical resection (P = .01). Median survival was 5.9 years (95% CI, 4.5-7.3) with the approach favoring biopsy only while median survival was not reached with the approach favoring early resection. Estimated 5-year survival was 60% (95% CI, 48%-72%) and 74% (95% CI, 64%-84%) for biopsy and watchful waiting and early resection, respectively. In an adjusted multivariable analysis the relative hazard ratio was 1.8 (95% CI, 1.1-2.9, P = .03) when treated at the center favoring biopsy and watchful waiting. Conclusions For patients in Norway with LGG, treatment at a center that favored early surgical resection was associated with better overall survival than treatment at a center that favored biopsy and watchful waiting. This survival benefit remained after adjusting for validated prognostic factors.Keywords
This publication has 35 references indexed in Scilit:
- Biopsy versus resection for the management of low-grade gliomasPublished by Wiley ,2011
- Comparative Effectiveness Research and Patients with Multiple Chronic ConditionsThe New England Journal of Medicine, 2011
- Response assessment in neuro-oncology (a report of the RANO group): assessment of outcome in trials of diffuse low-grade gliomasThe Lancet Oncology, 2011
- Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trialJournal of Neurosurgery, 2008
- EXTENT OF SURGICAL RESECTION IS INDEPENDENTLY ASSOCIATED WITH SURVIVAL IN PATIENTS WITH HEMISPHERIC INFILTRATING LOW-GRADE GLIOMASNeurosurgery, 2008
- Surgery Insight: the role of surgery in the management of low-grade gliomasNature Clinical Practice Neurology, 2007
- Low-grade gliomas: an update on pathology and therapyThe Lancet Neurology, 2005
- Supratentorial grade II astrocytoma: biological features and clinical courseThe Lancet Neurology, 2003
- Cognitive status and quality of life in patients with suspected versus proven low-grade gliomasNeurology, 2001
- Suspected low‐grade glioma: Is deferring treatment safe?Annals of Neurology, 1992