Does reintervention improve survival in recurrent glioblastoma? Facing a temporal bias in the literature

Background Glioblastoma (GBM) is the most frequent intraaxial malignant brain tumour, in which recurrence management is a frequent and demanding issue. Recently, reintervention has emerged as a useful tool for treatment. However, some new evidence has shown that most of the articles published could...

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Bibliographic Details
Published in:Acta neurochirurgica 2020-08, Vol.162 (8), p.1967-1975
Main Authors: Delgado-Fernández, Juan, Frade-Porto, Natalia, Blasco, Guillermo, González-Tarno, Patricia, Gil-Simoes, Ricardo, Li, Zhi-Qiang, Rivas, Paloma Pulido, de Sola, Rafael García
Format: Article
Language:English
Subjects:
Adult
Aged
Brain cancer
Brain Neoplasms - epidemiology
Brain Neoplasms - surgery
Brain tumors
Female
Glioblastoma
Glioblastoma - epidemiology
Glioblastoma - surgery
Humans
Interventional Radiology
Male
Medical prognosis
Medicine
Medicine & Public Health
Middle Aged
Minimally Invasive Surgery
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - surgery
Neurology
Neuroradiology
Neurosurgery
Neurosurgical Procedures - adverse effects
Neurosurgical Procedures - statistics & numerical data
Original Article - Brain Tumors
Postoperative Complications - epidemiology
Reoperation - adverse effects
Reoperation - statistics & numerical data
Statistical analysis
Statistics
Surgical Orthopedics
Survival
Survival Analysis
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Summary:Background Glioblastoma (GBM) is the most frequent intraaxial malignant brain tumour, in which recurrence management is a frequent and demanding issue. Recently, reintervention has emerged as a useful tool for treatment. However, some new evidence has shown that most of the articles published could have overestimated its effects. We aimed to analyse the effect on survival of reintervention considering it as a time-dependent variable and to compare it with classic statistical analysis. Methods We performed a retrospective study with GBM patients between 2007 and 2017. We compared the overall survival (OS) between reintervention and non-reintervention groups with time-dependent statistical methods (Simon-Makuch and landmarking methods and time-dependent multivariable Cox analysis) and compared them with those obtained with non-dependent time variable analysis. Results A total of 183 patients were included in the analysis and 44 of them were reoperated. The standard analysis with Kaplan-Meier and multivariable Cox regression of the cohort showed an OS of 22.2 months (95% CI 12.56–16.06) in the reintervention group and 11.8 months (95% CI 9.87–13.67) in the non-reintervention group ( p  
ISSN:0001-6268
0942-0940
DOI:10.1007/s00701-020-04432-4