Treatment by a specialist surgical neuro-oncologist does not provide any survival advantage for patients with a malignant glioma.
To determine whether patients with malignant glioma (glioblastoma and anaplastic astrocytoma) had longer survival times, and lower morbidity and mortality if operated on by a surgical neuro-oncologist rather than a general neurosurgeon the outcomes of 236 patients managed within a university surgical neurology department were analysed. Although both surgical morbidity (8.9 versus 11.8%) and mortality (3.6 versus 8.8%) were lower following surgery by the specialist neuro-oncologist neither difference was statistically significant. Crude outcome data suggested patients operated upon by a specialist surgical neuro-oncologist survived longer (p = 0.067). However, after adjustment for case mix (type of tumour, year of treatment, MRC prognostic index) using multiple logistic regression and a hazards model, there was no difference in outcome (p = 0.46, HR 0.884, 95% CI 0.639-1.22). This retrospective study (i) suggests that other outcome measures are required to validate specialist surgical neuro-oncologist treatment of patients with malignant glioma; and (ii) confirms the importance of adjustment for case mix when comparing non-randomized treatment outcomes.
Latif
A Z
AZ
Department of Clinical Neurosciences, Western General Hospital, Edinburgh, UK.
Signorini
D F
DF
Whittle
I R
IR
D001254:Astrocytoma / Q000401:mortality / Q000601:surgery*; D001932:Brain Neoplasms / Q000401:mortality / Q000601:surgery*; D002983:Clinical Competence; D005909:Glioblastoma / Q000401:mortality / Q000601:surgery*; D006801:Humans; D009493:Neurosurgery; D010348:Patient Care Team; D016016:Proportional Hazards Models; D012606:Scotland; D013038:Specialization; D016019:Survival Analysis