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Complete versus incomplete surgical resection in intramedullary astrocytoma: Systematic review with individual patient data meta-analysis
Golpayegani, Medi Edalatfar, Maryam Ahmadi, Ayat Sadeghi-Naini, Mohsen Salari, Farhad Hanaei, Sara Shokraneh, Farhad Ghodsi, Zahra Vaccaro, Alex R Rahimi-Movaghar, Vafa
Golpayegani, Medi
Edalatfar, Maryam
Ahmadi, Ayat
Sadeghi-Naini, Mohsen
Salari, Farhad
Hanaei, Sara
Shokraneh, Farhad
Ghodsi, Zahra
Vaccaro, Alex R
Rahimi-Movaghar, Vafa
Abstract
Study Design: Systematic review Background: Considering the infiltrative nature of intramedullary astrocytoma, the goal of surgery is to have a better patient related outcome.
Objective(s): To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma.
Method(s): A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI).
Result(s): We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P =.004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades.
Conclusion(s): Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma.
Objective(s): To compare the overall survival (OS) and neurologic outcomes of complete vs incomplete surgical resection for patients with intramedullary astrocytoma.
Method(s): A comprehensive search of MEDLINE, CENTRAL and EMBASE was conducted by two independent reviewers. Individual patient data (IPD) analysis and multivariate Cox Proportional Hazard Model was developed to measure the effect of surgical strategies on OS, post-operative neurological improvement (PNI), and neurological improvement in the last follow up (FNI).
Result(s): We included 1079 patients from 35 studies. Individual patient data of 228 patients (13 articles) was incorporated into the integrative IPD analysis. Kaplan-Meier survival analysis showed complete resection (CR) significantly improved OS in comparison with the incomplete resection (IR) (log-rank test, P =.004). In the multivariate IPD analysis, three prognostic factors had significant effect on the OS: (1) Extent of Resection, (2) pathology grade, and (3) adjuvant therapy. We observed an upward trend in the popularity of chemotherapy, but CR, IR, and radiotherapy had relatively stable trends during three decades.
Conclusion(s): Our study shows that CR can improve OS when compared to IR. Patients with spinal cord astrocytoma undergoing CR had similar PNI and FNI compared to IR. Therefore, CR should be the primary goal of surgery, but intraoperative decisions on the extent of resection should be relied on to prevent neurologic adverse events. Due to significant effect of adjuvant therapy on OS, PNI and FNI, it could be considered as the routine treatment strategy for spinal cord astrocytoma.
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Date
2022-04-29
Type
Article
Subject
Surgical Procedures, Operative, Life Expectancy, Mortality
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Citation
Golpayegani M, Edalatfar M, Ahmadi A, Sadeghi-Naini M, Salari F, Hanaei S, Shokraneh F, Ghodsi Z, Vaccaro AR, Rahimi-Movaghar V. Complete Versus Incomplete Surgical Resection in Intramedullary Astrocytoma: Systematic Review with Individual Patient Data Meta-Analysis. Global Spine J. 2023 Jan;13(1):227-241. doi: 10.1177/21925682221094766. Epub 2022 Apr 29.
Journal / Source Title
Global Spine Journal
DOI
PMID
35486519
Publisher
SAGE Publications
Publisher’s URL
Publisher’s statement
© The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/21925682221094766 journals.sagepub.com/home/gs. Creative Commons Non Commercial No Derivs CC BY-NC-ND: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits non-commercial use, reproduction and distribution of the work as published without adaptation or alteration, without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).