KEY TAKEAWAYS
- The study aimed to determine if resection improves survival over biopsy in elderly patients with glioblastoma through a meta-analysis.
- The primary endpoints were OS and PFS.
- The results showed upfront resection benefits OS and PFS in elderly patients with glioblastoma, despite increased complications.
Observational studies suggest that maximal-safe resection improves survival for older patients with glioblastoma. However, a clinical trial among surgically-accessible patients with glioblastoma found no survival benefits between resection and biopsy.
A meta-analysis is essential to assess whether surgical resection improves outcomes in older patients with brain cancer compared to biopsy alone.
Pavel S. Pichardo-Rojas and the team aimed to conduct a meta-analysis evaluating whether surgical resection improves surgical outcomes in elderly patients with glioblastoma compared to biopsy alone.
Researchers conducted a comprehensive search up to October 9th, 2023, across PubMed, MEDLINE, EMBASE, and COCHRANE databases to locate studies reporting clinical outcomes in glioblastoma patients aged over 65 who underwent either resection or biopsy.
Primary endpoints included overall survival (OS), progression-free survival (PFS), and postoperative complications. Survival outcomes were assessed using mean difference (MD) and hazard ratio (HR), while complications were analyzed using risk ratios (RR) as a categorical variable.
From 784 articles, they identified and included 20 cohort studies and 1 randomized controlled trial involving total 20,523 patients for analysis. Among patients who underwent surgical resection, the study found an increase in OS by an average of 6.13 months (95% CI: 2.43–9.82, P< 0.001) with a HR of 0.43 (95% CI: 0.35–0.52, P< 0.00001).
The PFS also showed an improvement, with a mean difference of 2.34 months (95% CI: 0.79–3.89, P= 0.003) and a HR favoring resection of 0.50 (95% CI: 0.37–0.68, P< 0.00001). However, the risk of postoperative complications was higher in the resection group compared to biopsy, with a RR of 1.49 (95% CI: 1.06–2.10).
The meta-analysis indicated that elderly patients with newly diagnosed glioblastoma benefit from upfront resection, showing improvements in OS and PFS compared to biopsy alone.
However, the study noted a higher incidence of postoperative complications associated with resection. Future clinical trials are crucial to further evaluate outcomes in this challenging patient group.
Funding was not applicable.
Source: https://link.springer.com/article/10.1007/s11060-024-04752-w
Pichardo-Rojas PS, Pichardo-Rojas D, Marín-Castañeda LA, et al. (2024). “Prognostic value of surgical resection over biopsy in elderly patients with glioblastoma: a meta-analysis.” J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04752-w
