title: Superior Efficacy of Gross Total Resection in Anaplastic Astrocytoma Patients Relative to Glioblastoma Patients.
abstract: BACKGROUND
  Because of their relative rarity, anaplastic astrocytomas (AAs) often are grouped with glioblastomas in clinical treatment paradigms. There are reasons, however, to expect that the therapeutic response of AAs may differ from those of glioblastoma. Here, we examined the clinical benefit of gross total resection (GTR) in AA relative to glioblastoma patients.
  
  
  METHODS
  Using the Surveillance, Epidemiology and End Results database, we identified 2755 patients with AA and patients with 21,962 glioblastoma between 1999 and 2010. Surgical resection was defined as GTR, subtotal resection (STR), biopsy only, or no resection. Kaplan-Meier curves and multivariate Cox regression were used to assess the association between GTR and survival.
  
  
  RESULTS
  The hazard of dying from the AA was reduced in GTR patients by 40% relative to STR patients. This reduction is 59% greater than that observed in glioblastoma where GTR was associated only with a 24% reduction relative to STR (P < 0.0001). The median survival for patients with AA who underwent GTR and subtotal resection were 64 and 24 months, respectively. For glioblastoma patients, the corresponding numbers for median survival were 13 and 9 months, respectively. The survival benefit of GTR in patients with AA was particularly notable in patient age < 50, where the median survival was not reached during the study period.
  
  
  CONCLUSIONS
  The Surveillance, Epidemiology and End Results data suggest that survival benefit associated with GTR was greater for patients with AA relative to glioblastoma patients, particularly for patients < age 50.
authors.affiliation: School of Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Padwal
authors.affiliation: School of Medicine, University of California, San Diego, La Jolla, California, USA; Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital (MGH), Boston, Massachusetts, USA.
authors.forename: Xuezhi
authors.initials: X
authors.lastname: Dong
authors.affiliation: Division of Neurological Surgery, University of California, San Diego, San Diego, California, USA.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Hirshman
authors.affiliation: Division of Neurological Surgery, University of California, San Diego, San Diego, California, USA.
authors.forename: U
authors.initials: U
authors.lastname: Hoi-Sang
authors.affiliation: Division of Neurological Surgery, University of California, San Diego, San Diego, California, USA.
authors.forename: Bob S
authors.initials: BS
authors.lastname: Carter
authors.affiliation: Division of Neurological Surgery, University of California, San Diego, San Diego, California, USA. Electronic address: clarkchen@ucsd.edu.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001254:Astrocytoma / Q000401:mortality* / Q000601:surgery*; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods / Q000401:mortality*; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Anaplastic astrocytoma; Brain tumor; Extent of resection; Glioblastoma; Glioma; SEER