P.159 Association Between Extent of Resection and Survival in Pediatric Patients with High-Grade Glioma: A Systematic Review and Meta-Analysis

Abstract

Background: While pediatric high-grade glioma (HGG) has a poor prognosis, the relationship between extent of resection (EOR), tumor location, and survival remains unclear. Our aim is to determine whether gross-total resection (GTR) is associated with prolonged survival relative to subtotal resection (STR) and biopsy. Methods: PubMed, Ovid EBM Reviews, Embase, and MEDLINE were systematically reviewed. Eligible articles were included for study-level and individual-patient data (IPD) meta-analysis. Difference by study-level and IPD characteristics were estimated using subgroup meta-analysis and meta-regression. PRISMA guidelines were followed. Results: In total, 33 studies were included. Study-level meta-analysis found GTR conferred decreased mortality relative to STR at 1 year (RR=0.73, 95%CI=0.59-0.89) and 2 years (RR=0.74, 95%CI=0.64-0.84). STR did not demonstrate survival advantages compared to biopsy at 1 year (RR=0.81, 95%CI=0.64-1.03), but showed decreased mortality at 2 years (RR=0.90, 95%CI=0.82-0.99). IPD meta-analysis comprised 186 patients, and indicated that STR (HR=2.61, 95%CI=1.56-4.38) and biopsy (HR=2.83, 95%CI=1.54-5.19) had shortened survival relative to GTR, with no differences between STR and biopsy (HR=0.93, 95%CI=0.55-1.56). In subgroup analysis, GTR was associated with prolonged survival for hemispheric tumors (HR=0.16, 95%CI=0.07-0.36) Conclusions: Among pediatric patients with HGGs, GTR was independently associated with better overall survival compared to STR and biopsy, especially in patients with hemispheric tumors.