Association of Maximal Extent of Resection of Contrast-Enhanced and Non–Contrast-Enhanced Tumor With Survival Within Molecular Subgroups of Patients With Newly Diagnosed Glioblastoma

For decades, debate has persisted regarding the role of surgical resection in newly diagnosed glioblastoma. There is increasing evidence that extent of resection (EoR) is an independent prognostic factor. Previous work has proposed the inclusion of EoR in a risk stratification algorithm but does not incorporate account recent advances in the molecular characterization of tumours. We set out to investigate the effect of EoR on overall survival (OS), and to develop a stratification algorithm incorporating both EoR and modern molecular markers for prognostication. HYPOTHESIS: Greater EoR is independently associated with improved OS. METHODS: We examined 190 consecutive cases of histopathologically confirmed newly-diagnosed glioblastoma who were operated upon between January 1, 2012 and December 31, 2014. Variables including age, sex, postal code, KPS, tumour location, presenting symptoms, treatment history, date of progression, date of reoperation, as well as MGMT, IDH, 1p/19q codeletion, and ATRX status were recorded. Preoperative and postoperative MRIs were reviewed and volumetric tumour burden will be analyzed and EoR will be calculated. RESULTS: Preliminary EoR calculations (n=18) show a positive correlation between EoR and OS. CONCLUSION: A correlation exists between EoR and OS, although multivariable analysis is planned to exclude potential confounders. MRI review, chart review including molecular marker analysis and EoR calculations are ongoing.

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Extent of Resection in Newly Diagnosed Glioblastoma: Impact of a Specialized Neuro-Oncology Care Center

Brain Sciences ◽

10.3390/brainsci8010005 ◽

2017 ◽

Vol 8 (1) ◽

pp. 5 ◽

Cited By ~ 16

Author(s):

Amer Haj ◽

Christian Doenitz ◽

Karl-Michael Schebesch ◽

Denise Ehrensberger ◽

Peter Hau ◽

...

Keyword(s):

Care Center ◽

Extent Of Resection ◽

Newly Diagnosed ◽

Newly Diagnosed Glioblastoma ◽

Oncology Care

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Macrovascular Networks on Contrast-Enhanced Magnetic Resonance Imaging Improves Survival Prediction in Newly Diagnosed Glioblastoma

Cancers ◽

10.3390/cancers11010084 ◽

2019 ◽

Vol 11 (1) ◽

pp. 84 ◽

Cited By ~ 3

Author(s):

Josep Puig ◽

Carles Biarnés ◽

Pepus Daunis-i-Estadella ◽

Gerard Blasco ◽

Alfredo Gimeno ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Prediction Models ◽

Survival Prediction ◽

Dynamic Susceptibility ◽

Imaging Features ◽

Newly Diagnosed ◽

Resonance Imaging ◽

Contrast Enhanced ◽

Newly Diagnosed Glioblastoma

A higher degree of angiogenesis is associated with shortened survival in glioblastoma. Feasible morphometric parameters for analyzing vascular networks in brain tumors in clinical practice are lacking. We investigated whether the macrovascular network classified by the number of vessel-like structures (nVS) visible on three-dimensional T1-weighted contrast–enhanced (3D-T1CE) magnetic resonance imaging (MRI) could improve survival prediction models for newly diagnosed glioblastoma based on clinical and other imaging features. Ninety-seven consecutive patients (62 men; mean age, 58 ± 15 years) with histologically proven glioblastoma underwent 1.5T-MRI, including anatomical, diffusion-weighted, dynamic susceptibility contrast perfusion, and 3D-T1CE sequences after 0.1 mmol/kg gadobutrol. We assessed nVS related to the tumor on 1-mm isovoxel 3D-T1CE images, and relative cerebral blood volume, relative cerebral flow volume (rCBF), delay mean time, and apparent diffusion coefficient in volumes of interest for contrast-enhancing lesion (CEL), non-CEL, and contralateral normal-appearing white matter. We also assessed Visually Accessible Rembrandt Images scoring system features. We used ROC curves to determine the cutoff for nVS and univariate and multivariate cox proportional hazards regression for overall survival. Prognostic factors were evaluated by Kaplan-Meier survival and ROC analyses. Lesions with nVS > 5 were classified as having highly developed macrovascular network; 58 (60.4%) tumors had highly developed macrovascular network. Patients with highly developed macrovascular network were older, had higher volumeCEL, increased rCBFCEL, and poor survival; nVS correlated negatively with survival (r = −0.286; p = 0.008). On multivariate analysis, standard treatment, age at diagnosis, and macrovascular network best predicted survival at 1 year (AUC 0.901, 83.3% sensitivity, 93.3% specificity, 96.2% PPV, 73.7% NPV). Contrast-enhanced MRI macrovascular network improves survival prediction in newly diagnosed glioblastoma.

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Impact of the Extent of Resection (EOR) on the Volume of Brain Tissue Exposed to Radiation in Patients With Newly Diagnosed Glioblastoma Multiforme (GBM)

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2012.07.703 ◽

2012 ◽

Vol 84 (3) ◽

pp. S270

Author(s):

M. Yondorf ◽

I. Kovanlikaya ◽

E. Bander ◽

J. Louissaint ◽

J. Kim ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Brain Tissue ◽

Extent Of Resection ◽

Newly Diagnosed ◽

Newly Diagnosed Glioblastoma

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Independently validated sex-specific nomograms for predicting survival in patients with newly diagnosed glioblastoma: NRG Oncology RTOG 0525 and 0825

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03886-5 ◽

2021 ◽

Author(s):

Nirav Patil ◽

Eashwar Somasundaram ◽

Kristin A. Waite ◽

Justin D. Lathia ◽

Mitchell Machtay ◽

...

Keyword(s):

Selection Procedure ◽

Extent Of Resection ◽

Newly Diagnosed ◽

Online Application ◽

Survival Probabilities ◽

Oncology Clinical Trials ◽

Newly Diagnosed Glioblastoma ◽

Cox Proportional Hazard Models ◽

Using Data ◽

User Friendly

Abstract Background/purpose Glioblastoma (GBM) is the most common primary malignant brain tumor. Sex has been shown to be an important prognostic factor for GBM. The purpose of this study was to develop and independently validate sex-specific nomograms for estimation of individualized GBM survival probabilities using data from 2 independent NRG Oncology clinical trials. Methods This analysis included information on 752 (NRG/RTOG 0525) and 599 (NRG/RTOG 0825) patients with newly diagnosed GBM. The Cox proportional hazard models by sex were developed using NRG/RTOG 0525 and significant variables were identified using a backward selection procedure. The final selected models by sex were then independently validated using NRG/RTOG 0825. Results Final nomograms were built by sex. Age at diagnosis, KPS, MGMT promoter methylation and location of tumor were common significant predictors of survival for both sexes. For both sexes, tumors in the frontal lobes had significantly better survival than tumors of multiple sites. Extent of resection, and use of corticosteroids were significant predictors of survival for males. Conclusions A sex specific nomogram that assesses individualized survival probabilities (6-, 12- and 24-months) for patients with GBM could be more useful than estimation of overall survival as there are factors that differ between males and females. A user friendly online application can be found here—https://npatilshinyappcalculator.shinyapps.io/SexDifferencesInGBM/.

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Impact of Postoperative Dexamethasone on Survival, Steroid Dependency, and Infections in Newly Diagnosed Glioblastoma Patients

Neuro-Oncology Practice ◽

10.1093/nop/npab039 ◽

2021 ◽

Author(s):

Akshitkumar M Mistry ◽

Sumeeth V Jonathan ◽

Meredith A Monsour ◽

Bret C Mobley ◽

Stephen W Clark ◽

...

Keyword(s):

Tumor Volume ◽

Cohort Analysis ◽

Absolute Lymphocyte Count ◽

Extent Of Resection ◽

Newly Diagnosed ◽

Steroid Dependency ◽

A Value ◽

Retrospective Cohort Analysis ◽

Newly Diagnosed Glioblastoma ◽

Outpatient Prescriptions

Abstract Background We examine the effect of dexamethasone prescribed in the initial 3 postoperative weeks on survival, steroid dependency, and infection in glioblastoma patients. Methods In this single-center retrospective cohort analysis, we electronically retrieved inpatient administration and outpatient prescriptions of dexamethasone and laboratory values from the medical record of 360 glioblastoma patients. We correlated total dexamethasone prescribed from postoperative day (POD) 0 to 21 with survival, dexamethasone prescription from POD30 to POD90, and diagnosis of an infection by POD90. These analyses were adjusted for age, KPS, tumor volume, extent of resection, IDH1/2 tumor mutation, tumor MGMT promoter methylation, temozolomide and radiotherapy initiation, and maximum blood glucose level. Results Patients were prescribed a median of 159 mg [109-190] of dexamethasone cumulatively by POD21. Every 16mg increment (4mg every 6 hours/day) of total dexamethasone associated with a 4% increase in mortality (95% confidence interval, CI, 1–7%, P<0.01), 12% increase in the odds of being prescribed dexamethasone from POD30-POD90 (95% CI 6–19%, P<0.01), and a 10% increase in the odds of being diagnosed with an infection (95% CI, 4–17%, P<0.01). Of the 175 patients who had their absolute lymphocyte count measured in the preoperative week, 80 (45.7%) had a value indicative of lymphopenia. In the POD1-POD28 period, this proportion was 82/167 (49.1%). Conclusions Lower survival, steroid dependency, and higher infection rate in glioblastoma patients associated with higher dexamethasone administration in the initial 3 postoperative weeks. Nearly half of the glioblastoma patients are lymphopenic preoperatively and up to one month postoperatively.

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A prognostic model of newly diagnosed glioblastoma based on clinical characteristics

10.21203/rs.3.rs-31518/v1 ◽

2020 ◽

Author(s):

Shengyu Fang ◽

Xing Fan ◽

Yinyan Wang ◽

Tao Jiang

Keyword(s):

Prognostic Model ◽

Survival Outcomes ◽

Survival Prediction ◽

Newly Diagnosed ◽

Total Resection ◽

Term Survival ◽

Contrast Enhanced ◽

Prediction Of Survival ◽

Idh Mutations ◽

Newly Diagnosed Glioblastoma

Abstract Background Using isocitrate dehydrogenase (IDH) mutations to classify survival outcomes of patients with glioblastoma multiforme was recommended based on novel histopathological classification of brain tumors. Considering this novel classification, it is unclear whether the extent of tumor resection (EOR) is still important. The aim of this study was to investigate prognostic value of clinical factors (age, sex, EOR, status of IDH mutations, and adjuvant therapy) in patients with newly diagnosed glioblastoma. Methods In total, 269 patients were retrospectively enrolled and randomly divided into training (n = 179) and validation (n = 90) cohorts. Clinical information and survival outcomes were acquired from inpatient records and follow-ups. After adjusting for risk coefficients, the independent prognostic factors were selected in a multivariable analysis to generate a model to evaluate survival outcomes. Additionally, a receiver operating characteristic curve was used to assess accuracy for predicting survival outcomes at 12, 15, 18, and 24 months. Results Total resection of the contrast-enhanced region, age ≤ 60 years, received chemotherapy, and IDH mutations were favorable independent factors for overall survival. Area under the curve (AUC) for prediction of survival in the training cohort was 0.815, 0.851, 0.849, and 0.836 at 12, 15, 18, and 24 months, respectively. In the validation cohort, the AUC for prediction of survival was 0.780, 0.807, 0.836, and 0.849 at 12, 15, 18, and 24 months, respectively. Conclusion Total resection of the contrast-enhanced region is still crucial and recommended for patients with glioblastoma. Our prognostic model was able to predict survival outcomes, especially for long-term survival prediction.

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Galectin-1 (Gal-1) expression as a prognostic factor in patients with newly diagnosed glioblastoma (GB) treated with Stupp regimen (GLIOCAT study).

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e13526 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e13526-e13526

Author(s):

Noelia Vilarino ◽

Neus Martinez-Bosch ◽

Carmen Balana ◽

Francesc Alameda ◽

Anna Estival ◽

...

Keyword(s):

Prognostic Factors ◽

Prognostic Factor ◽

Clinical Outcome ◽

Methylation Status ◽

Prognostic Significance ◽

Tumor Grade ◽

Extent Of Resection ◽

Newly Diagnosed ◽

Initial Surgery ◽

Newly Diagnosed Glioblastoma

e13526 Background: Gal-1 is a β-galactoside binding protein that plays an important role in cancer, promoting cell invasion, proliferation, migration, angiogenesis and evasion of the immune response. Gal-1 is involved in glioma progression and is related to tumor grade and poor clinical outcome. Gal-1 has been implicated in resistance to chemotherapy and as a potential mediator of resistance to anti-VEGF therapy. The aim of our study was to evaluate the prognostic significance of Gal-1 in a homogenous cohort of GB patients and to analyze its potential predictive value of response to bevacizumab at recurrence. Methods: A substudy of GLIOCAT, a multicenter study of newly diagnosed GB patients treated with standard Stupp regimen (previously reported). GLIOCAT enrolled 432 patients between 2005-2014. Tissue was available from 243 cases, from which a tissue microarray (TMA) was constructed. Gal-1 expression in tissue from initial surgery was analyzed by immunohistochemistry. Results were evaluated by three reviewers and quantified by H-score. Expression levels were correlated with clinical outcome, known GB prognostic factors and response to bevacizumab. Results: We defined a cut off for Gal-1 H-Score of >60 (cytoplasm) and >25 (nucleus). HighcytoplasmicGal-1 expression significantly correlated with worse OS and with a trend for shorter PFS. In the multivariate analysis KPS, age, MGMT methylation status and, extent of resection but not Gal-1 expression were independent prognostic factors for survival. Of 92 patients who received bevacizumab at recurrence, only 54 were included in the TMA, and only 1 had low Gal-1 expression. We couldn’t find any relationship with OS or PFS in this population. Conclusions: Gal-1 expression may represent a prognostic factor for GB patients treated with standard therapy. [Table: see text]

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