title: Evaluating extent of resection in pediatric glioblastoma: a multiple propensity score-adjusted population-based analysis.
abstract: OBJECTIVE
  The benefit of radical resections for glioblastoma patients remains a source of contention in the literature. Few studies have been conducted in pediatric patients, and it is becoming increasingly evident that data regarding adult glioblastoma (GB) patients cannot be generalized to pediatric patients affected by this neoplasm. A comparative effectiveness study is performed for different extent of resection (EOR) groups in the largest cohort of pediatric GB (pGB) patients.
  
  
  METHODS
  The Surveillance, Epidemiology, and End Results (SEER) cancer registry was used to identify pGB patients from 1988 through 2009. Multivariate- and multiple propensity score (mPS)-adjusted analyses were used to determine the effect of gross total resection (GTR), partial resection (PR), and biopsy (Bx) on overall survival. Survival prospects were summarized using direct adjusted survival curves.
  
  
  RESULTS
  A total of 342 pGB patients were identified, and 35.4 % of patients received a GTR, 28.8 % PR, 17.3 % Bx, and 17.0 % did not undergo surgery. In our cohort, a median overall survival of 12 months was observed with 1-, 2-, and 5-year survival rates of 51.7, 28.3, and 15.7 %, respectively. EOR was a predictor of survival in both the multivariate- (P < 0.001) and mPS-adjusted model (P < 0.001). Compared to the GTR group, a higher mortality rate was observed in patients who underwent a PR (HR 1.50; 95 % CI, 1.02-2.21) or Bx (HR 1.87; 95 % CI, 1.18-2.98). There were no significant differences in (adjusted) mortality risk between the PR and Bx groups.
  
  
  CONCLUSIONS
  Our study suggests that GTR is independently associated with improved survival for pediatric patients with glioblastoma.
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.|Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
authors.forename: Hadie
authors.initials: H
authors.lastname: Adams
authors.affiliation: Division of Neuro-Epidemiology, Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hieab H H
authors.initials: HH
authors.lastname: Adams
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Jackson
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
authors.forename: Jordina
authors.initials: J
authors.lastname: Rincon-Torroella
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA.
authors.forename: George I
authors.initials: GI
authors.lastname: Jallo
authors.affiliation: Department of Neurosurgery and Oncology, Johns Hopkins School of Medicine, 1550 Orleans Street, Cancer Research Building II Room 253, Baltimore, MD, 21231, USA. aquinon2@jhmi.edu.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Quiñones-Hinojosa
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D019635:Neurosurgical Procedures; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program
keywords: Extent of resection; GBM; Glioblastoma; Pediatric; Surgery; Survival