title: International Differences in Treatment and Clinical Outcomes for High Grade Glioma.
abstract: BACKGROUND
  High grade gliomas are the most common type of malignant brain tumor, and despite their rarity, cause significant morbidity and mortality. This study aimed to compare the treatment patterns of high grade glioma to examine survival patterns in patients who receive specific treatments between cohorts in Ohio and Taiwan.
  
  
  METHODS
  Patients aged 18 years and older at age of diagnosis with World Health Organization (WHO) grade III or IV astrocytoma from 2007-2012 were selected from the Ohio Brain Tumor Study and the Taiwan Cancer Registry. The treatment information was derived from medical chart reviews in Ohio and National Health Insurance Research Data in Taiwan. Treatment examined included surgical procedure (brain biopsy and/or resection), radiotherapy (radiation and/or radiosurgery), and alkylating chemotherapy. Kaplan-Meier and parametric survival models were used to examine the effect of treatment on survival, adjusted for age, sex, and comorbidities.
  
  
  RESULTS
  294 patients in Ohio and 1,097 patients in Taiwan met the inclusion criteria. 70.3% patients in Ohio and 51.4% in Taiwan received surgical resection, followed by concurrent chemoradiation. Patients who received this treatment had the highest survival rate, with a 1-year survival rate of 72.8% in Ohio and 73.4% in Taiwan. Patients who did not receive surgical resection, followed by concurrent chemoradiation had an increased risk of death (hazard ratio of 5.03 [95% confidence interval (CI): 3.61-7.02] in Ohio and 1.49 [95% CI: 1.31-1.71] in Taiwan) after adjustment for age, sex, and comorbidities.
  
  
  CONCLUSIONS
  Surgical resection followed by concurrent chemoradiation was associated with higher survival rate of patients with high grade glioma in both Ohio and Taiwan; however, one-third of patients in Ohio and half in Taiwan did not receive this treatment.
authors.affiliation: School of Health Care Administration, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Li-Nien
authors.initials: LN
authors.lastname: Chien
authors.affiliation: Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Quinn T
authors.initials: QT
authors.lastname: Ostrom
authors.affiliation: Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Haley
authors.initials: H
authors.lastname: Gittleman
authors.affiliation: Department of Neurosurgery, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Lin
authors.affiliation: Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Sloan
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.affiliation: Dardinger Neuro-Oncology Center, Department of Neurosurgery, James Comprehensive Cancer Center and The Ohio State University Medical Center, Columbus, Ohio, United States of America.
authors.forename: J Bradley
authors.initials: JB
authors.lastname: Elder
authors.affiliation: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
authors.forename: Christopher
authors.initials: C
authors.lastname: McPherson
authors.affiliation: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ronald
authors.initials: R
authors.lastname: Warnick
authors.affiliation: Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei, Taiwan; Center for Neurotrauma and Neuroregeneration, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yung-Hsiao
authors.initials: YH
authors.lastname: Chiang
authors.affiliation: Department of Neurosurgery, Taipei Medical University Wan-Fang Hospital, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Shuang-Ho Hospital, New Taipei City, Taiwan.
authors.forename: Chieh-Min
authors.initials: CM
authors.lastname: Lin
authors.affiliation: Brain Tumor and Neuro-Oncology Center, Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Lisa R
authors.initials: LR
authors.lastname: Rogers
authors.affiliation: School of Public Health, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hung-Yi
authors.initials: HY
authors.lastname: Chiou
authors.affiliation: Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America.
authors.forename: Jill S
authors.initials: JS
authors.lastname: Barnholtz-Sloan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D005260:Female; D005910:Glioma / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009820:Ohio; D016019:Survival Analysis; D013624:Taiwan; D016896:Treatment Outcome