Brain Tumor Res Treat.  2024 Jul;12(3):162-171. 10.14791/btrt.2024.0020.

Survival After Newly-Diagnosed High-Grade Glioma Surgery: What Can We Learn From the French National Healthcare Database?

• Depond CC
• Bauchet L
• Elhairech D
• Tuppin P
• Jecko V
• Weller J
• Metellus P

• KMID: 2558434
• DOI: http://doi.org/10.14791/btrt.2024.0020

Abstract

Background
This study aimed to assess the overall survival (OS) of patients after high-grade glio-ma (HGG) resection and to search for associated prognostic factors.
Methods
A random sample of ad hoc cases was extracted from the French medico-adminis- trative national database, Système National des Données de Santé (SNDS). We solely considered the patients who received chemoradiotherapy with temozolomide (TMZ/RT) after HGG surgery. Statistical survival methods were implemented.
Results
A total of 1,438 patients who had HGG resection at 58 different institutions between 2008 and 2019 were identified. Of these, 34.8% were female, and the median age at HGG resection was 63.2 years (interquartile range [IQR], 55.6–69.4 years). Median OS was 1.69 years (95% confidence interval [CI], 1.63–1.76), i.e., 20.4 months. Median age at death was 65.5 years (IQR, 58.5–71.8). OS at 1, 2, and 5 years was 78.5% (95% CI, 76.4–80.7), 40.3% (95% CI, 37.9–43), and 11.8% (95% CI, 10.2–13.6), respectively. In the adjusted Cox regression, female gender (HR=0.71; 95% CI, 0.63– 0.79; p<0.001), age at HGG surgery (HR=1.02; 95% CI, 1.02–1.03; p<0.001), TMZ treatment over 6 months after HGG surgery (HR=0.36; 95% CI, 0.32–0.4; p<0.001), bevacizumab (HR=1.22; 95% CI, 1.09–1.37; p<0.001), and redo surgery (HR=0.79; 95% CI, 0.67–0.93; p=0.005) remained significantly associated with the outcome.
Conclusion
The SNDS is a reliable source for studying the outcome of HGG patients. OS is better in younger patient, female gender, and those who complete concomitant chemoradiotherapy. Redo surgery for HGG recurrence was also associated with prolonged survival.

Keyword

High-grade glioma; Glioblastoma multiforme; Anaplastic astrocytoma; Outcome; Survival; Prognostic factors

Figure

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  Fig. 1 Selection of patients with newly diagnosed high-grade glioma. CI, confidence interval; TMZ, temozolomide; RT, radiotherapy; IQR, interquartile range.

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  Fig. 2 Kaplan-Meier curves for overall survival (OS). A: OS from date of birth. B: OS from high-grade glioma surgery. C: OS by gender. D: OS by age categories. E: OS by categories of comorbidity index. F: OS by tumor location.

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  Fig. 3 Kaplan-Meier curves for overall survival (OS) by treatment. A: OS by temozolomide duration over 6 months. B: OS by lomustine. C: OS by bevacizumab, with restricted mean survival time plot. D: OS by redo surgery for HGG recurrence.

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