EPID-05. PATTERNS OF RECOMMENDATION FOR SURGICAL INTERVENTION IN GRADE II, III, AND IV ASTROCYTOMAS: IMPLICATIONS FOR DELAYED DIAGNOSIS AND TREATMENT

Abstract

Abstract INTRODUCTION Timely surgical acquisition of tumor tissue for definitive diagnosis forms the foundation for early cancer diagnosis and treatment. Here we examined the pattern of surgical recommendations in the treatment of intracranial astrocytoma. METHODS Grade 2, 3, and 4 astrocytoma (abbreviated as A2, A3, and A4) patients who underwent biopsy for histologic diagnosis were identified in NCDB (2010-2021) and SEER (2004-2019) and divided into those who received recommendation for biopsy on initial presentation and those who received recommendation against surgery but ultimately underwent biopsy. Demographic, clinical characteristics, and survival outcomes of these cohorts were compared. RESULTS In both the NCDB and the SEER, patients ultimately diagnosed with A2 (NCDB: aOR=1.88, p< 0.001; SEER: aOR=1.77, p< 0.001) and A3 (NCDB: aOR=1.97, p< 0.001; SEER: aOR=1.78, p< 0.001) were less likely to receive recommendation for biopsy during initial encounter relative to patients with glioblastoma after adjusting the covariates. Other factors associated with decreased likelihood of recommendation for biopsy included: advanced age, deep cortical/infratentorial location, and smaller tumor size. These findings remain robust after accounting for dehydrogenase (IDH) mutation status, which was available in the NCDB after 2018. In a multivariable model accounting for survival-pertinent variables, including medical comorbidities, A2 (NCDB: aHR=1.23, p=0.006; SEER: aHR=1.15, p=0.039) and A3 (NCDB: aHR=1.44, p< 0.001; SEER: aHR=1.53, p< 0.001) patients who received recommendation against biopsy during initial encounter exhibited worse survival. CONCLUSION Patients with A2 and A3 are more likely to receive recommendation against surgical intervention on initial encounter. The associated survival pattern bears relevance to the potential impact of delayed diagnosis and treatment.