Outcomes of resecting subependymal giant cell astrocytoma (SEGA) among patients with SEGA-related tuberous sclerosis complex: a national claims database analysis

Abstract

Objective:

To examine the outcomes following resection of subependymal giant cell astrocytoma (SEGA) among patients with SEGA-associated tuberous sclerosis complex (TSC).

Methods:

Using three large US national healthcare claims databases, we retrospectively examined the outcomes of SEGA surgery among TSC patients who underwent SEGA surgery between 2000 and 2009. The examined outcomes were: prevalence rates of post-surgery SEGA, repeated SEGA surgery, and postoperative complications (surgical procedure complications, nervous system complications, postoperative infections, complications of subdural empyemas, and complications of epidural abscesses). Descriptive data analysis and two-sided one sample t-test for mean or proportion were used to assess the characteristics of patients and the outcomes of SEGA surgery.

Results:

The selected patients (N = 47) had a mean age of 11.6 years at their first SEGA surgery and 66% were male. During the third through twelfth months following surgery, 34% had post-surgery SEGA (diagnosis) and 12% underwent repeated SEGA surgeries. During the first post-surgery year, 48.9% of patients developed postoperative complications (34.0% had complications relating to the surgical procedure, 12.8% had nervous system complications, 6.4% developed postoperative infections, 17.0% had complications of subdural empyemas, and 2.1% had complications of epidural abscesses).

Conclusions:

SEGA surgery was associated with statistically significant risks of developing post-surgery SEGA, requiring repeated SEGA surgery and developing postoperative complications. Future efforts in reducing these outcomes, either through improving surgical procedures or through alternative treatments, are urgently needed.

Limitations:

This study has its limitation in data source representativeness and measurement accuracy.

Key words::

• Clinical effectiveness
• Repeated surgery
• SEGA recurrence
• Subependymal giant cell astrocytoma
• Surgical complications
• Tuberous sclerosis complex

Transparency

Declaration of funding

The funding of this project was provided by Novartis Pharmaceutical Corporation.

Declaration of financial/other relationships

P.S. has disclosed that he is employed by Kailo Research Group, a company that received unrestricted research grants from Novartis. J.L., A.G. and J.R. have disclosed that they are employed by Novartis, and own the company stocks. M.K. and D.K. have disclosed that they are consultants to Novartis. CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.