Predicting survival in anaplastic astrocytoma patients in a single-center cohort of 108 patients

Abstract Background Current guidelines for the treatment of anaplastic astrocytoma (AA) recommend maximal safe resection followed by radiotherapy and chemotherapy. Despite this multimodal treatment approach, patients have a limited life expectancy. In the present study, we identified variables associated with overall survival (OS) and constructed a model score to predict the OS of patients with AA at the time of their primary diagnosis. Methods We retrospectively evaluated 108 patients with newly diagnosed AA. The patient and tumor characteristics were analyzed for their impact on OS. Variables significantly associated with OS on multivariable analysis were included in our score. The final algorithm was based on the 36-month survival rates corresponding to each characteristic. Results On univariate analysis, age, Karnofsky performance status, isocitrate dehydrogenase status, and extent of resection were significantly associated with OS. On multivariable analysis all four variables remained significant and were consequently incorporated in the score. The total score ranges from 20 to 33 points. We designated three prognostic groups: A (20–25), B (26–29), and C (30–33 points) with 36-month OS rates of 23%, 71%, and 100%, respectively. The OS rate at 5 years was 8% in group A, 61% in group B and 88% in group C. Conclusions Our model score predicts the OS of patients newly diagnosed with AA and distinguishes patients with a poor survival prognosis from those with a greater life expectancy. Independent and prospective validation is needed. The upcoming changes of the WHO classification of brain tumors as well as the practice changing results from the CATNON trial will most likely require adaption of the score.

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PATH-16. EVALUATION OF SEX-BASED DIFFERENCES IN CLINICAL OUTCOMES AND TUMOR GENOMICS IN PATIENTS WITH NEWLY DIAGNOSED IDH-WILDTYPE GLIOBLASTOMA RECEIVING CHEMORADIATION

Neuro-Oncology ◽

10.1093/neuonc/noab196.468 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi118-vi118

Author(s):

Diana Shi ◽

Mary Jane Lim-Fat ◽

Amin Nassar ◽

Jared Woods ◽

Gilbert Youssef ◽

...

Keyword(s):

Clinical Outcomes ◽

Karnofsky Performance Status ◽

Performance Status ◽

Methylation Status ◽

Multivariable Analysis ◽

Extent Of Resection ◽

Hazard Ratio ◽

Newly Diagnosed ◽

Loss Of Function ◽

Female Sex

Abstract BACKGROUND We evaluated sex-based differences in clinical outcomes and tumor genomics in patients with newly-diagnosed GBM. METHODS We reviewed 665 IDH-wild type GBM patients with Karnofsky Performance Status (KPS) ≥60 treated at our institution from 2010-2019 including; 585 patients with targeted exome sequencing of 447 cancer associated genes (OncoPanel). Deleterious mutations were defined as homozygous deletions or loss of function mutations of known tumor suppressors (as reported in TCGA, ≥ 3 times in the COSMIC database, or predicted as “damaging” in SIFT and/or “probably damaging” in Polyphen 2) or known oncogenic mutations in proto-oncogenes (reported in TCGA or ≥ 3 times in COSMIC). RESULTS There were 384 (57.7%) males and 281 (42.3%) females. Median OS was 22.5 months for females and 19.3 months for males (hazard ratio [HR] 0.81, 95% CI 1.03-1.48, p = 0.02). On multivariable analysis adjusted for age, KPS ≥90, extent of resection, and MGMT methylation status, female sex (adjusted hazard ratio 0.78, 95% CI [0.64-0.95], p = 0.015) was associated with improved OS. Superior OS in females was observed in MGMT-unmethylated patients (HR 0.69, 95% CI [0.54-0.90], p = 0.005) but not MGMT-methylated patients. Thirteen genes were deleteriously altered in ≥5% of our cohort: CDK4 (12.1% male vs. 7.8% female), CDKN2A (46.5% vs. 45.7%), CDKN2B (41.8% vs. 43.3%), EGFR (34.7% vs. 40.0%, MTAP (18.2% vs. 18.8%), NF1 (11.5% vs. 9.4%), PTEN (28.2% vs. 29.8%), TP53 (28.2% vs. 30.2%), RB1 (5.6% vs. 6.5%), MDM4 (6.2% vs. 5.7%), ATM (5.9% vs. 3.7%), MDM2 (7.4% vs. 4.1%), PIK3R1 (6.2% vs. 4.1%). There were no differences in frequency of mutations in these individual genes between males and females (χ 2 [1, N=585] = 0.05-2.86, p = 0.09-0.86). CONCLUSIONS Female sex is associated with improved survival. We did not identify sex-based differences in deleterious genomic alterations amongst commonly altered genes in GBM.

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Phase II study of continuous infusion carmustine and cisplatin followed by cranial irradiation in adults with newly diagnosed high-grade astrocytoma.

Journal of Clinical Oncology ◽

10.1200/jco.1997.15.7.2596 ◽

1997 ◽

Vol 15 (7) ◽

pp. 2596-2603 ◽

Cited By ~ 55

Author(s):

S A Grossman ◽

M Wharam ◽

V Sheidler ◽

L Kleinberg ◽

M Zeltzman ◽

...

Keyword(s):

Progressive Disease ◽

Karnofsky Performance Status ◽

Performance Status ◽

Survival Rates ◽

Cranial Irradiation ◽

Significant Activity ◽

High Grade ◽

Newly Diagnosed ◽

Intracranial Hemorrhages ◽

High Grade Astrocytoma

PURPOSE To evaluate the activity and toxicity of carmustine (BCNU) and cisplatin administered as a 72-hour continuous intravenous infusion before radiation in adults with newly diagnosed high-grade astrocytomas. PATIENTS AND METHODS Fifty-two patients with a Karnofsky performance status greater than 60 and no prior antineoplastic therapy entered this protocol. The median age of the patients was 55 years. Eighty-eight percent had glioblastoma multiforme and 12% had anaplastic astrocytomas. BCNU (40 mg/m2/d) and cisplatin (40 mg/m2/d) were administered concurrently as a 72-hour infusion every 3 to 4 weeks. Radiation was begun 4 weeks after the third cycle of chemotherapy or earlier for progressive disease. Responses required a > or = 50% reduction in contrast-enhancing volume. RESULTS Forty patients (77%) completed three chemotherapy infusions, five (10%) received two infusions, and seven (13%) received only one. Fifty-one patients completed radiation. Seventeen (42%) patients with measurable disease had a partial response (PR) to chemotherapy, 23 (53%) had stable disease (SD), and two (4%) had progressive disease (PD) on chemotherapy. The median survival time for all patients was 13 months. Survival rates at 1, 2, 3, and 5 years were 62%, 19%, 12%, and 5%, respectively. Grade III to IV leukopenia occurred in 32% of patients; 63% received platelet transfusions and 58% required RBCs. Neutropenic fevers were rare and no intracranial hemorrhages or treatment-related deaths were noted. Nausea, vomiting, peripheral neuropathy, hearing loss, and thromboembolic events were relatively common. CONCLUSION This chemotherapy regimen appears to have significant activity and may prolong survival in adults with newly diagnosed high-grade astrocytoma.

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P14.31 CMV reactivation in a cohort of newly-diagnosed glioblastoma patients treated with temozolomide chemoradiotherapy. A single center analysis

Neuro-Oncology ◽

10.1093/neuonc/noz126.266 ◽

2019 ◽

Vol 21 (Supplement_3) ◽

pp. iii73-iii74

Author(s):

R URSU ◽

J Doridam ◽

E Chaugne ◽

H Zannou ◽

C Belin ◽

...

Keyword(s):

Clinical Symptoms ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Progression Free Survival ◽

Newly Diagnosed ◽

Single Center ◽

Positive Serology ◽

Cd4 Lymphocyte ◽

Cmv Reactivation

Abstract BACKGROUND The Cytomegalovirus (CMV) is a ubiquitous herpes virus which infects 60–80 % of the population in Europe. Although the CMV usually remains latent, reactivation can occur in the context of an immunodepression, such as low CD4-lymphocyte levels in HIV patients. Glioblastoma (GBM) patients frequently show lymphopenia, which is related to both the immunosuppressive nature of the tumor and to the treatment with concomitant temozolomide (TMZ) and radiotherapy (RT). Surprisingly, the incidence of CMV reactivation in GBM patients has not been clearly studied so far. We report here our experience on CMV reactivation in a cohort of newly-diagnosed GBM patients, treated with RT and TMZ. We assessed the incidence of CMV reactivation in these patients and tried to identify risk factors for such reactivation. MATERIAL AND METHODS All consecutive patients with histologically confirmed malignant GBM recommended for temozolomide chemoradiotherapy in our institution from October 2013 to December 2015 were reviewed. In all patients, sex, age, Karnofsky performance status (KPS), lymphocyte level, serological CMV status and steroid dosages were recorded at the onset, and one month after completion of the concomitant radio-chemotherapy regimen. A CMV reactivation was defined by a detection of CMV DNA > 1000 copies/ml in the patient’s serum. RESULTS 103 patients meeting the analysis criteria were reviewed. Within these 103 patients, 34 patients (33%) had initial negative serology for CMV, and none of them developed a seroconversion after treatment with concomitant RT + TMZ. Among patients with positive IgG (n=69), 16 patients (23%) developed a positive viremia at one point during treatment with concomitant RT + TMZ. Age (>60 years), lymphocyte count before RT (<1500/mm3) and use of steroids were correlated with CMV reactivation (p<0.05 in univariate analysis). A positive CMV viremia during RT+TMZ did not impact the progression free survival (PFS) but was associated with a shorter overall survival (OS) when compared to the others patients (median: 12 months vs 15 months; p=0.04). No clinical symptoms suggestive of CMV infection were reported. CONCLUSION In this single center series, we showed that CMV reactivation occurs in 23% of the GBM patients having a positive serology for CMV. Reactivation was more frequent in older patients, with low lymphocyte counts and treated with steroids. A positive viremia was not associated with poor PFS, a fact that does not support a promoting role of CMV in glioma oncogenesis, which has been sometimes suggested. Yet, the group of patients with CMV reactivation showed a shorter OS, which might be related to an older age and /or poorer clinical conditions in this group.

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A Nomogram Predicts Individual Prognosis in Patients With Newly Diagnosed Glioblastoma by Integrating the Extent of Resection of Non-Enhancing Tumors

Frontiers in Oncology ◽

10.3389/fonc.2020.598965 ◽

2020 ◽

Vol 10 ◽

Author(s):

Zhe Zhang ◽

Zeping Jin ◽

Dayuan Liu ◽

Yang Zhang ◽

Chunzhao Li ◽

...

Keyword(s):

Dna Methyltransferase ◽

Proportional Hazards Model ◽

Predictive Accuracy ◽

Karnofsky Performance Status ◽

Performance Status ◽

Extent Of Resection ◽

Cox Proportional Hazards Model ◽

Newly Diagnosed ◽

Discriminative Ability ◽

Newly Diagnosed Glioblastoma

BackgroundThe extent of resection of non-contrast enhancing tumors (EOR-NCEs) has been shown to be associated with prognosis in patients with newly diagnosed glioblastoma (nGBM). This study aimed to develop and independently validate a nomogram integrated with EOR-NCE to assess individual prognosis.MethodsData for this nomogram were based on 301 patients hospitalized for nGBM from October 2011 to April 2019 at the Beijing Tiantan Hospital, Capital Medical University. These patients were randomly divided into derivation (n=181) and validation (n=120) cohorts at a ratio of 6:4. To evaluate predictive accuracy, discriminative ability, and clinical net benefit, concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were calculated for the extent of resection of contrast enhancing tumor (EOR-CE) and EOR-NCE nomograms. Comparison between these two models was performed as well.ResultsThe Cox proportional hazards model was used to establish nomograms for this study. Older age at diagnosis, Karnofsky performance status (KPS)<70, unmethylated O6-methylguanine-DNA methyltransferase (MGMT) status, wild-type isocitrate dehydrogenase enzyme (IDH), and lower EOR-CE and EOR-NCE were independent factors associated with shorter survival. The EOR-NCE nomogram had a higher C-index than the EOR-CE nomogram. Its calibration curve for the probability of survival exhibited good agreement between the identical and actual probabilities. The EOR-NCE nomogram showed superior net benefits and improved performance over the EOR-CE nomogram with respect to DCA and ROC for survival probability. These results were also confirmed in the validation cohort.ConclusionsAn EOR-NCE nomogram assessing individualized survival probabilities (12-, 18-, and 24-month) for patients with nGBM could be useful to provide patients and their relatives with health care consultations on optimizing therapeutic approaches and prognosis.

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Clinical Outcome and Toxicity in the Treatment of Anaplastic Thyroid Cancer in Elderly Patients

Journal of Clinical Medicine ◽

10.3390/jcm9103231 ◽

2020 ◽

Vol 9 (10) ◽

pp. 3231

Author(s):

Teresa Augustin ◽

Dmytro Oliinyk ◽

Viktoria Florentine Koehler ◽

Josefine Rauch ◽

Claus Belka ◽

...

Keyword(s):

Systematic Review ◽

Thyroid Cancer ◽

Prognostic Factor ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Survival Rates ◽

Progression Free Survival ◽

Anaplastic Thyroid Cancer ◽

Pooled Analysis

Background: The present study aims to evaluate the outcomes and toxicity of elderly anaplastic thyroid cancer (ATC) patients receiving (chemo)radiotherapy, as well as to identify prognostic factors. Patients and methods: A systematic review using the MEDLINE/PubMed and Cochrane databases was performed. Individual data from all eligible studies were extracted, and a pooled analysis (n = 186) was conducted to examine patient characteristics and treatment. All consecutive ATC patients (≥65 years) treated between 2009 and 2019 at our institution were evaluated for outcomes concerning progression-free survival (PFS), overall survival (OS) probabilities and treatment-related toxicity. Results: The systematic review and pooled analysis identified age as a prognostic factor. The median OS of our patient cohort (n = 26) was three months (range = 0–125). The 6-, 12- and 24-month survival rates were 35%, 22% and 11%, respectively. In the univariate analysis, a Karnofsky performance status of >70%, the Union for International Cancer Control Tumor–Node–Metastasis classification, multimodal therapy and an EQD2 of >49 Gy were correlated with longer OS and PFS. The acute grade 3 toxicity of dysphagia, dyspnea, dermatitis, mucositis and dysphonia was found in 23%, 15%, 12%, 12% and 8% of patients. Conclusion: Age appears to be a prognostic factor in ATC. Elderly ATC patients can tolerate multimodal treatment and achieve a promising outcome. Prospective studies need to confirm our findings.

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Retrospective and Randomized Analysis of Influence and Correlation of Clinical and Molecular Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR

Brain Sciences ◽

10.3390/brainsci10020091 ◽

2020 ◽

Vol 10 (2) ◽

pp. 91

Author(s):

Maurizio Salvati ◽

Placido Bruzzaniti ◽

Michela Relucenti ◽

Mariagrazia Nizzola ◽

Pietro Familiari ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Survival Rates ◽

Progression Free Survival ◽

Extent Of Resection ◽

Primary Brain Tumor ◽

Ki 67 ◽

Significant Survival ◽

Operator Series ◽

University Of Rome

Glioblastoma is a solid, infiltrating, and the most frequent highly malignant primary brain tumor. Our aim was to find the correlation between sex, age, preoperative Karnofsky performance status (KPS), presenting with seizures, and extent of resection (EOR) with overall survival (OS), progression-free survival (PFS), and postoperative KPS, along with the prognostic value of IDH1, MGMT, ATRX, EGFR, and TP53 genes mutations and of Ki67 through the analysis of a single-operator series in order to avoid the biases of a multi-operator series, such as the lack of homogeneity in surgical and adjuvant nonsurgical treatments. A randomized retrospective analysis of 122 patients treated by a single first operator at Sapienza University of Rome was carried out. After surgery, patients followed standard Stupp protocol treatment. Exclusion criteria were: (1) patients with primary brainstem and spinal cord gliomas and (2) patients who underwent partial resections (resection < 90%) or a biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried out through the use of SPSS 25® (IBM). Results showed statistically significant survival increase in four groups: (1) patients treated with gross total resection (GTR) (p < 0.030); (2) patients with mutation of IDH1 (p < 0.0161); (3) patients with methylated MGMT promoter (p < 0.005); (4) patients without EGFR amplification or EGFRvIII mutation (p < 0.035). Higher but not statistically significant survival rates were also observed in: patients <75 years, patients presenting with seizures at diagnosis, patients affected by lesions in noneloquent areas, as well as in patients with ATRX gene mutation and Ki-67 < 10%.

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The Prognostic Factors and Outcome of Adult Medulloblastoma: Where We Stand

International Surgery ◽

10.9738/intsurg-d-16-00104.1 ◽

2016 ◽

Vol 101 (7-8) ◽

pp. 352-360

Author(s):

Kamuran Ibis ◽

Ahmet Karadeniz ◽

Rasim Meral ◽

Murat Guveli ◽

Mert Basaran ◽

...

Keyword(s):

Prognostic Factors ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Survival Rates ◽

Disease Free Survival ◽

Craniospinal Irradiation ◽

Subtotal Resection ◽

Duration Of Symptoms ◽

Adult Medulloblastoma

We designed our study to analyze the prognostic factors and treatment outcomes of adult medulloblastoma patients who received postoperative craniospinal irradiation. Fourty-three patients who were treated due to medulloblastoma at Istanbul University, Institute of Oncology between 1990 and 2013 were retrospectively analyzed. All of the patients were older than 18 years, with a median age of 27 years (range, 18–51 years). In 40 (93%) patients, total resection of the tumor was achieved, and 3 (7%) patients had undergone a subtotal tumoral resection. Risk assessment revealed 7 high-risk and 36 standard-risk patients. All patients received postoperative craniospinal irradiation, delivering a median craniospinal dose of 36 Gy, with an additional boost to the posterior fossa up to 54 Gy. Fifteen patients received chemotherapy. The median follow-up was 62 months (range, 3–213 months). The 5-year, 10-year, overall, and disease-free survival rates were 63%, 51%, 66%, and 55%, respectively. Univariate analysis revealed that hydrocephalus, initial local recurrence, subtotal resection in primary surgery, initial Karnofsky performance status ≤70, duration of symptoms shorter than 30 days, and primary site dose < 54 Gy were found to be negative prognostic factors. Toxicity was moderate. The main therapy in adult medulloblatoms is craniospinal irradiation following surgery. The prognostic factors and outcomes of the patients in our study are concordant with previous reports in the literature.

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Independent predictors of survival and the impact of repeat surgery in patients undergoing surgical treatment of spinal metastasis

Journal of Neurosurgery Spine ◽

10.3171/2012.8.spine12449 ◽

2012 ◽

Vol 17 (6) ◽

pp. 565-576 ◽

Cited By ~ 25

Author(s):

Darryl Lau ◽

Matthew R. Leach ◽

Frank La Marca ◽

Paul Park

Keyword(s):

Karnofsky Performance Status ◽

Spinal Metastasis ◽

Performance Status ◽

Survival Rates ◽

Multivariable Analysis ◽

Cancer Type ◽

Survival Times ◽

Repeat Surgery ◽

Metastatic Recurrence ◽

The Impact

Object Surgery for spinal metastasis is considered palliative, and postoperative survival is often less than a year. Recurrence of metastatic lesions is quite common, and it remains unclear whether repeat surgery is effective. In this study, the authors assessed independent predictors for survival at 6 months, 1 year, and 2 years after surgery, and examined whether repeat surgery for recurrence of spinal metastasis influenced survival rates. Methods Retrospective review of the electronic medical records was performed to identify a consecutive population of adult patients who underwent surgery for spinal metastasis during the period 2005–2011. Utilizing a Cox proportional hazard regression model, the authors assessed independent predictors and risk factors for survival at 6 months, 1 year, and 2 years after surgery. In addition, the impact of repeat surgery on survival was specifically assessed via multivariable analysis. Results A total of 99 patients were included in the final analysis. The overall mean postoperative duration of survival was 9.6 months. In addition to previously identified predictors of survival (preoperative ambulation, Karnofsky Performance Status [KPS], radiotherapy, primary cancer type, presence of extraspinal metastasis, and number of spinal segments with metastasis), pain on presentation and body mass index (BMI) of 25–30 were both independently associated with survival. Patients with recurrence who underwent repeat surgery had longer mean survival times than patients with recurrence who did not undergo repeat surgery (19.6 months vs 12.8 months, respectively). Repeat surgery was also independently associated with higher survival rates on multivariate analysis. Follow-up KPS was significantly higher in patients who underwent repeat surgery as well. Conclusions In addition to confirming previously identified predictors of survival following surgery for spinal metastasis, the authors identified BMI and pain on presentation as independent predictors of survival. They also found that repeat surgery may be a viable option in patients with metastatic recurrence and may offer prolonged survival, likely due to improved functionality, mitigating complications associated with immobility.

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Electrolyte and renal disorders in patients with newly diagnosed glioblastoma

10.21203/rs.3.rs-84298/v1 ◽

2020 ◽

Author(s):

Daniela Pierscianek ◽

Marvin Darkwah Oppong ◽

Yahya Ahmadipour ◽

Laurèl Rauschenbach ◽

Anna Michel ◽

...

Keyword(s):

Renal Function ◽

Clinical Performance ◽

Performance Status ◽

Strong Association ◽

Univariate Analysis ◽

Extent Of Resection ◽

Prognostic Impact ◽

Newly Diagnosed ◽

Renal Disorders ◽

The Impact

Abstract BackgroundElectrolyte disturbances and altered renal function have been linked to the prognosis of critically ill patients and recently also of cancer patients. Little is known about the prevalence and prognostic impact of electrolyte and renal disorders in patients with glioblastoma (GBM), the most frequent malignant primary brain tumor. This study aimed to assess electrolyte and renal disorders in GBM patients and evaluate their effect on patients’ outcome.MethodsPatients treated for newly diagnosed GBM between 2005 and 2018 were included. Electrolytes and renal function parameters were assessed preoperatively. Medical records of patients were retrospectively reviewed for demographic and clinical parameters, as well as patients’ survival.ResultsElectrolyte and renal disorders at admission were present in 275 (30.6%) and 544 (60.4%) of 900 GBM patients respectively and were more common in patients with higher age, previous comorbidities and poor initial clinical performance status. In univariate analysis and Kaplan-Meier survival plots, presence of hyponatremia, hypochloremia, hypocalcemia, hyperuricemia and low glomerular filtration rate were associated with poorer survival. Multivariate analysis revealed hypochloremia as an independent prognostic factor for overall (p=0.004) and 1-year (p=0.021) survival. ConclusionsPreoperative electrolyte and renal disorders are common in GBM patients. Of them, only hypochloremia showed a strong association with GBM prognosis, independently of age, sex, extent of resection, clinical performance status, postoperative therapy, and molecular status. Further studies are needed to evaluate the impact of hypochloremia on GBM survival.

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Retrospective and Randomized Analysis of Influence and Correlation of Molecular and Clinical Prognostic Factors in a Mono-Operative Series of 122 Patients with Glioblastoma Treated with STR or GTR

10.20944/preprints201912.0382.v1 ◽

2019 ◽

Author(s):

Maurizio Salvati ◽

Placido Bruzzaniti ◽

Michela Rilucenti ◽

Mariagrazia Nizzola ◽

Pietro Familiari ◽

...

Keyword(s):

Karnofsky Performance Status ◽

Performance Status ◽

Survival Rates ◽

Brain Biopsy ◽

Progression Free Survival ◽

Extent Of Resection ◽

Primary Brain Tumor ◽

Ki 67 ◽

Single Operator ◽

University Of Rome

Glioblastoma is a solid, infiltrating and the most frequent highly malignant primary brain tumor. Our aim was to find the prognostic value of mutations of IDH1, MGMT, EGFR, p53, ATRX, Ki67 genes and the correlation between sex, age, presenting with seizures, number of interventions, extent of resection with Overall Survival (OS), Progression Free Survival (PFS) and Karnofsky performance status (KPS) score. A randomized retrospective analysis of 122 patients treated by a single operator at Sapienza University of Rome, was carried out. After surgery patients followed standard treatment Stupp protocol [6]. Exclusion criteria were: patients with primitive brainstem and spinal cord gliomas and patients who underwent partial resections (resection < 90%) and cases of brain biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried on by SPSS 25 ® (IBM) program. Results showed statistically significant survival increase in four groups: 1) patients treated with gross total resection (p< 0.03); 2) patients with methylated MGMT promoter (p<0.005); 3) patients with non EGFR amplification or EGFRvIII mutation (p<0.035); 4) mutated IDH1/IDH2 (p<0.0161). Higher survival rates (but not statistically significant) were observed also in patients with: age < 75 years, Ki 67 <10%, lesions in non eloquent areas, ATRX gene mutation and presentation with seizures.

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