Treatment and surgical factors associated with longer-term glioblastoma survival: a National Cancer Database study

Background Insufficient data exist to characterize factors associated with longer-term survival of glioblastoma (GBM). A population-based analysis of GBM longer-term survivors (LTS) in the United States was conducted to investigate the association between treatment, demographic, surgical factors, and longer-term survival. Methods From the National Cancer Database, GBM patients were identified using ICD-O-3 histology codes 9440-9442/3, 2005-2015 and were divided into routine (<= 3 years) and longer-term (>3 years) overall survival (OS) groups. Univariable and multivariable logistic regression analysis was used to assess factors associated with longer-term survival. A subset analysis was performed to further investigate the association of extent of resection and treatment combinations on OS outcomes. Results A total of 93 036 patients with GBM met study criteria. Among these patients, 8484 were LTS and 84 552 were routine survivors (RS). When comparing LTS (OS of >3 years) with RS (OS of <= 3 years), younger age, insured status, metro/urban residence, treatment at academic facility, and fewer comorbidities were associated with longer-term survival. In addition, trimodality therapy (chemotherapy + radiation + surgery) was associated with having best odds of longer-term survival (odds ratio = 4.89, 95% confidence interval [3.58, 6.68]); 74% of LTS received such therapy compared with 51% of RS. Subset analysis revealed that total resection is only associated with longer-term survival status for those receiving trimodality therapy or surgery only. Conclusions In a population-based analysis, standard of care surgery and chemo radiation connote a survival advantage in GBM. Among those receiving standard of care, having a total resection is most beneficial for longer-term survival status.