TREATMENT BY A SPECIALIST SURGICAL NEURO-ONCOLOGIST DOES NOT PROVIDE ANY SURVIVAL ADVANTAGE FOR PATIENTS WITH A MALIGNANT GLIOMA

To determine whether patients with malignant glioma (glioblastoma and anaplastic astrocytoma) had longer survival times, and lower morbidity and mortality if operated on by a surgical neuro-oncologist rather th an a general neurosurgeon the outcomes of 236 patients managed within a university surgical neurology department were analysed. Although bot h surgical morbidity (8.9 versus 11.8%) and mortality (3.6 versus 8.8% ) were lower following surgery by the specialist neuro-oncologist neit her difference was statistically significant. Crude outcome data sugge sted patients operated upon by a specialist surgical neuro-oncologist survived longer (p = 0.067). However, after adjustment for case mix (t ype of tumour, year of treatment, MRC prognostic index) using multiple logistic regression and a hazards model, there was no difference in o utcome (p = 0.46, HR 0.884, 95% CI 0.659-1.22). This retrospective stu dy (i) suggests that other outcome measures are required to validate s pecialist surgical neuro-oncologist treatment of patients with maligna nt glioma; and (ii) confirms the importance of adjustment for case mix when comparing non-randomized treatment outcomes.