Maximum Resection and Immunotherapy Improve Glioblastoma Patient Survival: A Single-institution Prognostic Analysis
Abstract Purpose. Glioblastoma (GBM) is a refractory disease with a poor prognosis and various methods, including maximum resection and immunotherapy, have been tested to improve outcomes. This retrospective study analyzed the prognostic factors of initially diagnosed glioblastoma patients at our institution to analyze the effect of these methods on prognosis. Methods. Two hundred seventy-seven patients with initially diagnosed glioblastoma who were treated in our institution from 2009 to 2020. Various data, including extent of removal (EOR) and type of adjuvant therapy, were examined and prognostic relationships were analyzed. Results. The median OS of the entire 277-case cohort, 200 non-biopsy cases, and 77 biopsy cases were 16.6 months, 19.7 months, and 9.7 months, respectively. Gross total removal (GTR; 100% of EOR) was achieved in 32.9% of the cases. Univariate analysis revealed younger age, right side, higher Karnofsky performance status, GTR, intraoperative MRI use for removal, proton therapy, combination immunotherapy, and discharge to home as good prognostic factors. Intraoperative MRI use and EOR were closely related. In the multivariate analysis, GTR, proton therapy, and combination of immunotherapies including autologous formalin-fixed tumor vaccine were the significant prognostic factors. A multivariate analysis of 91 GTR cases showed that immunotherapy contributed to prognostic improvements. The median OS and 5-year OS% values were 36.9 months and 43.3% in GTR cases receiving immunotherapy. Conclusion. GTR, proton therapy, and immunotherapy were good prognostic factors in single-center GBM cases. Tumor vaccine therapy for GTR cases achieved a notably high median survival time and long-term survival ratio, indicating its usefulness in GTR cases.