Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis

Kaiyun Yang, Siddharth Nath, Alex Koziarz, Jetan H. Badhiwala, Huphy Ghayur, Michel Sourour, Dragos Catana, Farshad Nassiri, Mazen B. Alotaibi, Michelle Kameda-Smith, Branavan Manoranjan, Mohammed H. Aref, Seyed Alireza Mansouri, Sheila Singh, Saleh A. Almenawer

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.

Original languageEnglish (US)
Pages (from-to)e762-e775
JournalWorld neurosurgery
Volume120
DOIs
StatePublished - Dec 1 2018

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Glioma
Meta-Analysis
Confidence Intervals
Biopsy
Odds Ratio
Survival
Seizures
Morbidity
Mortality
Disease-Free Survival
Databases
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Yang, K., Nath, S., Koziarz, A., Badhiwala, J. H., Ghayur, H., Sourour, M., ... Almenawer, S. A. (2018). Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis. World neurosurgery, 120, e762-e775. https://doi.org/10.1016/j.wneu.2018.08.163
Yang, Kaiyun ; Nath, Siddharth ; Koziarz, Alex ; Badhiwala, Jetan H. ; Ghayur, Huphy ; Sourour, Michel ; Catana, Dragos ; Nassiri, Farshad ; Alotaibi, Mazen B. ; Kameda-Smith, Michelle ; Manoranjan, Branavan ; Aref, Mohammed H. ; Mansouri, Seyed Alireza ; Singh, Sheila ; Almenawer, Saleh A. / Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma : A Systematic Review and Meta-Analysis. In: World neurosurgery. 2018 ; Vol. 120. pp. e762-e775.
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title = "Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis",
abstract = "Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95{\%} confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95{\%} CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8{\%} with biopsy to 54.2{\%} with STR and 81.0{\%} with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95{\%} CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95{\%} CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95{\%} CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.",
author = "Kaiyun Yang and Siddharth Nath and Alex Koziarz and Badhiwala, {Jetan H.} and Huphy Ghayur and Michel Sourour and Dragos Catana and Farshad Nassiri and Alotaibi, {Mazen B.} and Michelle Kameda-Smith and Branavan Manoranjan and Aref, {Mohammed H.} and Mansouri, {Seyed Alireza} and Sheila Singh and Almenawer, {Saleh A.}",
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Yang, K, Nath, S, Koziarz, A, Badhiwala, JH, Ghayur, H, Sourour, M, Catana, D, Nassiri, F, Alotaibi, MB, Kameda-Smith, M, Manoranjan, B, Aref, MH, Mansouri, SA, Singh, S & Almenawer, SA 2018, 'Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma: A Systematic Review and Meta-Analysis', World neurosurgery, vol. 120, pp. e762-e775. https://doi.org/10.1016/j.wneu.2018.08.163

Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma : A Systematic Review and Meta-Analysis. / Yang, Kaiyun; Nath, Siddharth; Koziarz, Alex; Badhiwala, Jetan H.; Ghayur, Huphy; Sourour, Michel; Catana, Dragos; Nassiri, Farshad; Alotaibi, Mazen B.; Kameda-Smith, Michelle; Manoranjan, Branavan; Aref, Mohammed H.; Mansouri, Seyed Alireza; Singh, Sheila; Almenawer, Saleh A.

In: World neurosurgery, Vol. 120, 01.12.2018, p. e762-e775.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Biopsy Versus Subtotal Versus Gross Total Resection in Patients with Low-Grade Glioma

T2 - A Systematic Review and Meta-Analysis

AU - Yang, Kaiyun

AU - Nath, Siddharth

AU - Koziarz, Alex

AU - Badhiwala, Jetan H.

AU - Ghayur, Huphy

AU - Sourour, Michel

AU - Catana, Dragos

AU - Nassiri, Farshad

AU - Alotaibi, Mazen B.

AU - Kameda-Smith, Michelle

AU - Manoranjan, Branavan

AU - Aref, Mohammed H.

AU - Mansouri, Seyed Alireza

AU - Singh, Sheila

AU - Almenawer, Saleh A.

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.

AB - Background: The role of the extent of surgical resection (EOR) in clinical outcomes for patients with low-grade glioma requires further examination. The goal of the present study was to evaluate the association between variable degrees of EOR and clinical outcomes for patients with low-grade glioma. Methods: We conducted a systematic review and meta-analysis and searched databases for reports of low-grade glioma EOR. Eligible studies compared patient outcomes, including ≥2 categories of EOR (biopsy, resection of any extent, subtotal resection [STR], or gross total resection [GTR]). Treatment effects were evaluated using pooled estimates, mean differences, or risk ratios (RRs) with corresponding 95% confidence intervals (CIs) using random effects modeling. Results: Our literature search yielded 60 studies with 13,289 patients. Pooled estimates of overall survival (OS) showed an increase from 3.79 years in the biopsy group to 6.68 years in STR to 10.65 years in GTR. OS was favorable with resection of any extent compared with (mean difference, 3.24; 95% CI, 0.64–5.84; P = 0.015). Pooled estimates of seizure control showed an improvement from 47.8% with biopsy to 54.2% with STR and 81.0% with GTR. Compared with STR, GTR delayed malignant transformation (RR, 0.43; 95% CI, 0.20–0.93; P = 0.032), without increasing postoperative mortality (RR, 0.38; 95% CI, 0.07–1.97; P = 0.250) or morbidity (RR, 1.22; 95% CI, 0.65–2.28; P = 0.540). Conclusion: Among patients with low-grade gliomas, greater degrees of safe EOR were associated with longer OS and progression-free survival, better seizure control, and delayed malignant transformation, without increasing mortality or morbidity.

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U2 - 10.1016/j.wneu.2018.08.163

DO - 10.1016/j.wneu.2018.08.163

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