Rate of biopsy prior to resection among patients with high-grade glioma: a nationwide database analysis.

Abstract

In cases of high-grade glioma that ultimately proceed to resection, a purely diagnostic biopsy might be unnecessary and add undue risk and cost. The frequency of resection following biopsy in a short time frame has not been reported among patients with high-grade glioma using a nationwide database. The objective of this study was to determine the occurrence rate of resection within 60 days of biopsy among patients with high-grade glioma and to determine if this occurrence is associated with patient or hospital characteristics. This retrospective cohort study used a large private health insurance database to identify adult patients who underwent craniotomy for resection of high-grade glioma and received radiation treatment and temozolomide within 90 days of surgery from 2006 to 2022. This patient cohort was also queried for patients who underwent surgery for biopsy within the 60 days preceding craniotomy. The patient and hospital-related factors associated with biopsy within 60 days prior to resection were then examined. A total of 3051 patients who underwent resection of high-grade glioma were included; 106 patients (3.5%) underwent additional surgery for biopsy within 60 days prior to resection. The likelihood of undergoing additional surgery for biopsy prior to resection decreased with increasing age (in 5-year increments, OR 0.93 [95% CI 0.87-0.99]; p = 0.04). Patients who underwent biopsy were significantly younger (p = 0.02). The Northeast region had the highest rate of preresection biopsies (4.1%, 11/267). Most patients (93.1%, 94/101) underwent preresection biopsy at non-high-volume centers, and 24.5% (23/94) of these patients subsequently underwent resection at a high-volume center. A low proportion of patients with high-grade glioma underwent additional surgery for biopsy prior to resection. This finding provides a baseline as preresection biopsy might become more common in the context of investigational drug development requiring pretreatment baseline specimens.