Radiotherapy Is Associated With Improved Overall Survival in Adult Pineoblastoma: A SEER Database Analysis.

OBJECTIVE: Pineoblastomas (PBLs) are rare high-grade tumors treated variably with surgery and/or radiation. The role of surgical extent of resection and radiotherapy (RT) in adult PBL remains unclear. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess these variables' effects on overall survival (OS) in adult PBL. METHODS: The SEER (1975-2016) database was queried for adult patients with diagnosis of PBL (ICD-0-3: 9362/3). Variables extracted included age, sex, race, geographical region, extent of tumor resection, RT, chemotherapy (CT), and OS data. Comparisons were performed with the χ2 test for categorical variables, Cox proportional hazards models to assess the association of clinical variables on OS, and Kaplan-Meier curves were generated. RESULTS: A total of 201 patients with PBL were identified with mean age 40.0 years (interquartile range 27.0-51.0) and most patients being male (53%) and Caucasian (77%). 101 (50%) patients received RT, and gross total resection was achieved in 83 (41%). Age stratification by decade revealed statistically significant poorer OS in patients aged ≥70 years. In bivariate analysis, RT with or without surgery was associated with improved 5-year OS compared with no RT (77.3% vs. 63.2%, P = 0.020). In multivariate analysis, age was a poor prognostic factor for OS (P < 0.001) and RT did appear to improve survival (P = 0.020). Extent of surgical resection was not significantly associated with improved survival. CONCLUSIONS: In adult patients with PBL, RT may offer an OS benefit irrespective of surgery or extent of surgical resection. Patients ≥70 years of age are associated with poorer OS.

Novel Predictive Models for High-Value Care Outcomes Following Glioblastoma Resection.

BACKGROUND: Treating patients with glioblastoma (GBM) requires extensive medical infrastructure. Individualized risk assessment for extended length of stay (LOS), nonroutine discharge disposition, and increased total hospital charges is critical to optimize delivery of care. Our study sought to develop predictive models identifying independent risk factors for these outcomes. METHODS: We retrospectively reviewed patients undergoing GBM resection at our institution between January 2017 and September 2020. Extended LOS and elevated hospital charges were defined as values in the upper quartile of the cohort. Nonroutine discharge was defined as any disposition other than to home. Multivariate models for each outcome included covariates demonstrating P ≤ 0.10 on bivariate analysis. RESULTS: We identified 265 patients undergoing GBM resection, with an average age of 58.2 years. 24.5% of patients experienced extended LOS, 22.6% underwent nonroutine discharge, and 24.9% incurred elevated total hospital charges. Decreasing Karnofsky Performance Status (KPS) (P = 0.004), increasing modified 5-factor frailty (mFI-5) index (P = 0.012), lower surgeon experience (P = 0.005), emergent surgery (P < 0.0001), and larger tumor volume (P < 0.0001) predicted extended LOS. Independent predictors of nonroutine discharge included older age (P = 0.02), decreasing KPS (P < 0.0001), and emergent surgery (P = 0.048). Nonprivate insurance (P = 0.011), decreasing KPS (P = 0.029), emergent surgery (P < 0.0001), and larger tumor volume (P = 0.004) predicted elevated hospital charges. These models were incorporated into an open-access online calculator (https://neurooncsurgery3.shinyapps.io/gbm_calculator/). CONCLUSIONS: Several factors were independent predictors for at least 1 high-value care outcome, with lower KPS and emergent admission associated with each outcome. These models and our calculator may help clinicians provide individualized postoperative risk assessment to glioblastoma patients.