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Meta-Analysis
. 2015 Jun;17(6):868-81.
doi: 10.1093/neuonc/nou349. Epub 2015 Jan 3.

Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis

Saleh A Almenawer  1 , Jetan H Badhiwala  1 , Waleed Alhazzani  1 , Jeffrey Greenspoon  1 , Forough Farrokhyar  1 , Blake Yarascavitch  1 , Almunder Algird  1 , Edward Kachur  1 , Aleksa Cenic  1 , Waseem Sharieff  1 , Paula Klurfan  1 , Thorsteinn Gunnarsson  1 , Olufemi Ajani  1 , Kesava Reddy  1 , Sheila K Singh  1 , Naresh K Murty  1
Affiliations
Meta-Analysis

Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis

Saleh A Almenawer et al. Neuro Oncol. 2015 Jun.

Abstract

Background: Optimal extent of surgical resection (EOR) of high-grade gliomas (HGGs) remains uncertain in the elderly given the unclear benefits and potentially higher rates of mortality and morbidity associated with more extensive degrees of resection.

Methods: We undertook a meta-analysis according to a predefined protocol and systematically searched literature databases for reports about HGG EOR. Elderly patients (≥60 y) undergoing biopsy, subtotal resection (STR), and gross total resection (GTR) were compared for the outcome measures of overall survival (OS), postoperative karnofsky performance status (KPS), progression-free survival (PFS), mortality, and morbidity. Treatment effects as pooled estimates, mean differences (MDs), or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) were determined using random effects modeling.

Results: A total of 12 607 participants from 34 studies met eligibility criteria, including our current cohort of 211 patients. When comparing overall resection (of any extent) with biopsy, in favor of the resection group were OS (MD 3.88 mo, 95% CI: 2.14-5.62, P < .001), postoperative KPS (MD 10.4, 95% CI: 6.58-14.22, P < .001), PFS (MD 2.44 mo, 95% CI: 1.45-3.43, P < .001), mortality (RR = 0.27, 95% CI: 0.12-0.61, P = .002), and morbidity (RR = 0.82, 95% CI: 0.46-1.46, P = .514) . GTR was significantly superior to STR in terms of OS (MD 3.77 mo, 95% CI: 2.26-5.29, P < .001), postoperative KPS (MD 4.91, 95% CI: 0.91-8.92, P = .016), and PFS (MD 2.21 mo, 95% CI: 1.13-3.3, P < .001) with no difference in mortality (RR = 0.53, 95% CI: 0.05-5.71, P = .600) or morbidity (RR = 0.52, 95% CI: 0.18-1.49, P = .223).

Conclusions: Our findings suggest an upward improvement in survival time, functional recovery, and tumor recurrence rate associated with increasing extents of safe resection. These benefits did not result in higher rates of mortality or morbidity if considered in conjunction with known established safety measures when managing elderly patients harboring HGGs.

Keywords: elderly; extent of resection; malignant glioma; meta-analysis; systematic review.

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Figures

Fig. 1.
Fig. 1.
Flow chart of study selection process.
Fig. 2.
Fig. 2.
Forest plots of the meta-analyses comparing overall resection (of any extent) vs biopsy. Outcomes evaluated are: (A) mean difference in OS time, in months, (B) mean difference in postoperative KPS, (C) mean difference in PFS, in months, (D) mortality, and (E) morbidity.
Fig. 2.
Fig. 2.
Forest plots of the meta-analyses comparing overall resection (of any extent) vs biopsy. Outcomes evaluated are: (A) mean difference in OS time, in months, (B) mean difference in postoperative KPS, (C) mean difference in PFS, in months, (D) mortality, and (E) morbidity.
Fig. 3.
Fig. 3.
Forest plots of the meta-analyses evaluating the mean difference in OS time, in months, between: (A) STR and biopsy, (B) GTR and biopsy, and (C) GTR and STR.
See this image and copyright information in PMC

Comment in

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