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. 2018 Jul:115:e59-e66.
doi: 10.1016/j.wneu.2018.03.163. Epub 2018 Apr 6.

Glioblastoma Survival Outcomes at a Tertiary Hospital in Appalachia: Factors Impacting the Survival of Patients Following Implementation of the Stupp Protocol

Ogaga Urhie  1 , Ryan Turner  2 , Brandon Lucke-Wold  1 , Walid Radwan  2 , Janice Ahn  3 , Kymberly Gyure  3 , Sanjay Bhatia  4
Affiliations

Glioblastoma Survival Outcomes at a Tertiary Hospital in Appalachia: Factors Impacting the Survival of Patients Following Implementation of the Stupp Protocol

Ogaga Urhie et al. World Neurosurg. 2018 Jul.

Abstract

Background: Glioblastoma is a fatal brain cancer with low median and yearly survival rates. Standard of care for treating glioblastoma is gross total resection (GTR) coupled with the Stupp protocol, but various factors influence the interventions undertaken and survival achieved. As health disparities exist in rural areas, survival in these areas needs to be assessed to understand which factors detract from the successes of these standard medical interventions.

Methods: We retrospectively determined impact of age at diagnosis, number of lesions, the molecular marker O6-methylguanine methyltransferase (MGMT), extent of surgery, and completion of the Stupp protocol on survival in patients treated at West Virginia University Hospitals. We also compared our findings with a pre-Stupp protocol study done in West Virginia in 1996.

Results: Age <60 years at diagnosis, having the MGMT gene methylated, having a unifocal tumor, receiving GTR, adhering to the Stupp protocol, and undergoing a treatment course of GTR followed by the Stupp protocol significantly increased survival. Comparison with the 1996 study showed that although overall median survival has not increased, all interventions involving GTR have resulted in a significantly higher survival.

Conclusions: We can serve our patient population by offering GTR to all adult patients with glioblastoma when no contraindications exist and ensuring that patients follow the Stupp protocol. After discharge, the Stupp protocol may not be followed or completed for a variety of reasons. In the future, we aim to assess these reasons and analyze other significant interventional and socioeconomic factors that influence survival.

Keywords: Appalachia; Glioblastoma; Gross total resection (GTR); Median survival; Rural areas; Stupp protocol; West Virginia.

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Conflict of interest statement

Conflicts of interest: The authors declare having no conflicts of interest

Figures

Figure 1
Figure 1
Bar graphs showing median survival in months, with SE, according to prognostic indicators of survival: a) age at diagnosis; b) MGMT methylation status; c) number of lesions; d) surgical intervention; e) completion of the Stupp protocol; f) treatment course
Figure 2
Figure 2
Kaplan Meier curves of cumulative probability of survival over time according to: a) age at diagnosis; b) MGMT methylation status; c) number of lesions; d) surgical intervention; e) completion of the Stupp protocol; f) treatment course
See this image and copyright information in PMC

References

    1. Agnihotri S, Gajadhar AS, Ternamian C, Gorlia T, Diefes KL, Mischel PS, Kelly J, McGown G, Thorncroft M, Carlson BL, Sarkaria JN, Margison GP, Aldape K, Hawkins C, Hegi M, Guha A. Alkylpurine-DNA-N-glycosylase confers resistance to temozolomide in xenograft models of glioblastoma multiforme and is associated with poor survival in patients. J Clin Invest. 2012;122:253–266. - PMC - PubMed

    1. America’s Health Rankings Annual Report 2016 edition (2017) © United Health Foundation (USA)

    1. Appalachian Regional Commission. Maps by topic: economic status. Available at: http://www.arc.gov/research/MapsofAppalachia.asp?F_CATEGORY_ID=1.
    1. Appalachian Regional Commission. Social Determinants. Creating a culture of health in Appalachia: Disparities and bright spots. Available at https://www.arc.gov/assets/research_reports/Health_Disparities_in_Appala....
    1. Appalachian Regional Commission. The Appalachian Region. Available at: http://www.arc.gov/appalachian_region/TheAppalachianRegion.asp.

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