Evaluating the Association Between the Extent of Resection and Survival in Gliosarcoma

 Gliosarcoma (GS) is a rare, malignant mixed tumor of the central nervous system with a median survival of approximately 13 months across multiple studies. Although the value of the extent of resection (EOR) has been confirmed as a prognostic survival factor in glioblastoma, no such association has...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2019-04, Vol.11 (4), p.e4374-e4374
Main Authors: Ahmed, Fahad I, Abdullah, Kalil G, Durgin, Joseph, Salinas, Ryan D, O'Rourke, Donald M, Brem, Steven
Format: Article
Language:English
Subjects:
Dehydrogenases
Epidermal growth factor
Glioma
Medical prognosis
Metastasis
Neurosurgery
NMR
Nuclear magnetic resonance
Patients
Software
Statistical analysis
Volumetric analysis
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Summary: Gliosarcoma (GS) is a rare, malignant mixed tumor of the central nervous system with a median survival of approximately 13 months across multiple studies. Although the value of the extent of resection (EOR) has been confirmed as a prognostic survival factor in glioblastoma, no such association has been defined for GS. The goal of this study was to establish an association between EOR and survival and to determine if a threshold of resection exists for which a survival benefit is conferred in GS. The authors identified 11 patients with histologically confirmed GS between January 2005 and January 2015, treated at the Hospital of the University of Pennsylvania. Clinical, radiographic, and outcome data were retrospectively reviewed. Volumetric analysis was completed using semi-automated segmentation to measure the change in contrast-enhancing material based on preoperative T1-contrast (T1c) and postoperative T1 & T1c magnetic resonance imaging (MRI) scans. A log-rank test was completed to confirm an association between EOR and survival, and a series of Kaplan-Meier curves were constructed to determine an EOR threshold. Univariate Cox proportional hazards model (CPHM) followed by multivariate CPHM was also completed to evaluate associations between the prognostic clinical and immunohistochemistry variables under consideration.  Extent of resection categories were defined as gross total resection (GTR >95%), subtotal resection (STR 90%-95%), and partial resection (PR
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.4374