SURG-20. Association Between Extent Of Surgical Resection And Overall Survival In Intracranial High-Grade Gangliogliomas: An Analysis From The National Cancer Database

Abstract High-grade (anaplastic) gangliogliomas are rare malignant glioneuronal tumors characterized by aggressive behavior and poor prognosis. While surgical resection is a mainstay of treatment, limited evidence exists on whether GTR confers a survival advantage over STR. This study evaluates whether gross total resection (GTR) is associated with improved overall survival compared to subtotal resection (STR) in patients with intracranial high-grade gangliogliomas. The National Cancer Database (NCDB) was queried for patients diagnosed with intracranial high-grade gangliogliomas (histology code 9505; behavior code 3) between 2004 and 2019 who underwent surgical resection. Patients were stratified by extent of resection (GTR vs. STR). Multivariable Cox proportional hazards analysis was performed, adjusting for age, sex, ethnicity, race, facility type, comorbidities, tumor size, adjuvant radiotherapy, and systemic therapy. Among 74 patients meeting inclusion criteria, 56.76% were male. Most were under 40 years old (47.30%), followed by those over 60 (28.38%) and those aged 40–60 (24.32%). GTR was achieved in 37 patients (50.00%), and STR in 37 (50.00%). Mean survival following GTR was 43.76 months, compared to 21.72 months for STR. On multivariate analysis, STR was associated with significantly increased mortality risk compared to GTR (hazard ratio [HR]=2.50, p=0.0117). Additional predictors of worse survival included male sex (HR=2.35, p=0.0190) and increasing age (HR=1.04, p=0.0002). Adjuvant radiotherapy and chemotherapy were not significantly associated with survival. GTR is associated with significantly improved overall survival compared to STR in high-grade gangliogliomas. This NCDB analysis suggests that maximal safe resection, alongside consideration of patient-specific factors like age and sex, may confer a survival benefit—underscoring the importance of complete tumor removal when feasible in managing anaplastic ganglioglioma.