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Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis

Overview of attention for article published in Lancet Oncology, April 2016
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  • In the top 25% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (86th percentile)
  • Good Attention Score compared to outputs of the same age and source (65th percentile)

Mentioned by

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17 tweeters
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1 patent

Citations

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157 Dimensions

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213 Mendeley
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Title
Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis
Published in
Lancet Oncology, April 2016
DOI 10.1016/s1470-2045(15)00581-1
Pubmed ID
Authors

Eric M Thompson, Thomas Hielscher, Eric Bouffet, Marc Remke, Betty Luu, Sridharan Gururangan, Roger E McLendon, Darell D Bigner, Eric S Lipp, Sebastien Perreault, Yoon-Jae Cho, Gerald Grant, Seung-Ki Kim, Ji Yeoun Lee, Amulya A Nageswara Rao, Caterina Giannini, Kay Ka Wai Li, Ho-Keung Ng, Yu Yao, Toshihiro Kumabe, Teiji Tominaga, Wieslawa A Grajkowska, Marta Perek-Polnik, David C Y Low, Wan Tew Seow, Kenneth T E Chang, Jaume Mora, Ian F Pollack, Ronald L Hamilton, Sarah Leary, Andrew S Moore, Wendy J Ingram, Andrew R Hallahan, Anne Jouvet, Michelle Fèvre-Montange, Alexandre Vasiljevic, Cecile Faure-Conter, Tomoko Shofuda, Naoki Kagawa, Naoya Hashimoto, Nada Jabado, Alexander G Weil, Tenzin Gayden, Takafumi Wataya, Tarek Shalaby, Michael Grotzer, Karel Zitterbart, Jaroslav Sterba, Leos Kren, Tibor Hortobágyi, Almos Klekner, Bognár László, Tímea Pócza, Peter Hauser, Ulrich Schüller, Shin Jung, Woo-Youl Jang, Pim J French, Johan M Kros, Marie-Lise C van Veelen, Luca Massimi, Jeffrey R Leonard, Joshua B Rubin, Rajeev Vibhakar, Lola B Chambless, Michael K Cooper, Reid C Thompson, Claudia C Faria, Alice Carvalho, Sofia Nunes, José Pimentel, Xing Fan, Karin M Muraszko, Enrique López-Aguilar, David Lyden, Livia Garzia, David J H Shih, Noriyuki Kijima, Christian Schneider, Jennifer Adamski, Paul A Northcott, Marcel Kool, David T W Jones, Jennifer A Chan, Ana Nikolic, Maria Luisa Garre, Erwin G Van Meir, Satoru Osuka, Jeffrey J Olson, Arman Jahangiri, Brandyn A Castro, Nalin Gupta, William A Weiss, Iska Moxon-Emre, Donald J Mabbott, Alvaro Lassaletta, Cynthia E Hawkins, Uri Tabori, James Drake, Abhaya Kulkarni, Peter Dirks, James T Rutka, Andrey Korshunov, Stefan M Pfister, Roger J Packer, Vijay Ramaswamy, Michael D Taylor

Abstract

Patients with incomplete surgical resection of medulloblastoma are controversially regarded as having a marker of high-risk disease, which leads to patients undergoing aggressive surgical resections, so-called second-look surgeries, and intensified chemoradiotherapy. All previous studies assessing the clinical importance of extent of resection have not accounted for molecular subgroup. We analysed the prognostic value of extent of resection in a subgroup-specific manner. We retrospectively identified patients who had a histological diagnosis of medulloblastoma and complete data about extent of resection and survival from centres participating in the Medulloblastoma Advanced Genomics International Consortium. We collected from resections done between April, 1997, and February, 2013, at 35 international institutions. We established medulloblastoma subgroup affiliation by gene expression profiling on frozen or formalin-fixed paraffin-embedded tissues. We classified extent of resection on the basis of postoperative imaging as gross total resection (no residual tumour), near-total resection (<1·5 cm(2) tumour remaining), or sub-total resection (≥1·5 cm(2) tumour remaining). We did multivariable analyses of overall survival and progression-free survival using the variables molecular subgroup (WNT, SHH, group 4, and group 3), age (<3 vs ≥3 years old), metastatic status (metastases vs no metastases), geographical location of therapy (North America/Australia vs rest of the world), receipt of chemotherapy (yes vs no) and receipt of craniospinal irradiation (<30 Gy or >30 Gy vs no craniospinal irradiation). The primary analysis outcome was the effect of extent of resection by molecular subgroup and the effects of other clinical variables on overall and progression-free survival. We included 787 patients with medulloblastoma (86 with WNT tumours, 242 with SHH tumours, 163 with group 3 tumours, and 296 with group 4 tumours) in our multivariable Cox models of progression-free and overall survival. We found that the prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. We identified a progression-free survival benefit for gross total resection over sub-total resection (hazard ratio [HR] 1·45, 95% CI 1·07-1·96, p=0·16) but no overall survival benefit (HR 1·23, 0·87-1·72, p=0·24). We saw no progression-free survival or overall survival benefit for gross total resection compared with near-total resection (HR 1·05, 0·71-1·53, p=0·8158 for progression-free survival and HR 1·14, 0·75-1·72, p=0·55 for overall survival). No significant survival benefit existed for greater extent of resection for patients with WNT, SHH, or group 3 tumours (HR 1·03, 0·67-1·58, p=0·89 for sub-total resection vs gross total resection). For patients with group 4 tumours, gross total resection conferred a benefit to progression-free survival compared with sub-total resection (HR 1·97, 1·22-3·17, p=0·0056), especially for those with metastatic disease (HR 2·22, 1·00-4·93, p=0·050). However, gross total resection had no effect on overall survival compared with sub-total resection in patients with group 4 tumours (HR 1·67, 0·93-2·99, p=0·084). The prognostic benefit of increased extent of resection for patients with medulloblastoma is attenuated after molecular subgroup affiliation is taken into account. Although maximum safe surgical resection should remain the standard of care, surgical removal of small residual portions of medulloblastoma is not recommended when the likelihood of neurological morbidity is high because there is no definitive benefit to gross total resection compared with near-total resection. Canadian Cancer Society Research Institute, Terry Fox Research Institute, Canadian Institutes of Health Research, National Institutes of Health, Pediatric Brain Tumor Foundation, and the Garron Family Chair in Childhood Cancer Research.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 213 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 2 <1%
Canada 1 <1%
Czechia 1 <1%
Italy 1 <1%
France 1 <1%
Japan 1 <1%
United States 1 <1%
Unknown 205 96%

Demographic breakdown

Readers by professional status Count As %
Researcher 35 16%
Other 33 15%
Student > Ph. D. Student 23 11%
Student > Master 23 11%
Student > Bachelor 16 8%
Other 50 23%
Unknown 33 15%
Readers by discipline Count As %
Medicine and Dentistry 98 46%
Neuroscience 20 9%
Biochemistry, Genetics and Molecular Biology 16 8%
Agricultural and Biological Sciences 13 6%
Nursing and Health Professions 5 2%
Other 15 7%
Unknown 46 22%

Attention Score in Context

This research output has an Altmetric Attention Score of 12. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 May 2020.
All research outputs
#1,838,338
of 16,849,755 outputs
Outputs from Lancet Oncology
#1,881
of 5,541 outputs
Outputs of similar age
#37,420
of 268,222 outputs
Outputs of similar age from Lancet Oncology
#53
of 149 outputs
Altmetric has tracked 16,849,755 research outputs across all sources so far. Compared to these this one has done well and is in the 89th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,541 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 27.5. This one has gotten more attention than average, scoring higher than 66% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 268,222 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 86% of its contemporaries.
We're also able to compare this research output to 149 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 65% of its contemporaries.