Symptom resolution in infiltrating WHO grade II-IV glioma patients undergoing surgical resection

Prediagnostic symptoms and signs of adult glioma: the patients' view

BACKGROUND

Little is known about the symptoms glioma patients experience in the year before diagnosis, either or not resulting in health care usage. This study aimed to determine the incidence of symptoms glioma patients experienced in the year prior to diagnosis, and subsequent visits to a general practitioner (GP).

METHODS

Glioma patients were asked to complete a 30-item study-specific questionnaire focusing on symptoms they experienced in the 12 months before diagnosis. For each indicated symptom, patients were asked whether they consulted the GP for this issue.

RESULTS

Fifty-nine patients completed the questionnaires, 54 (93%) with input of a proxy. The median time since diagnosis was 4 months (range 1-12). The median number of symptoms experienced in the year before diagnosis was similar between gliomas with favourable and poor prognosis, i.e. 6 (range 0-24), as were the five most frequently mentioned problems: fatigue (n = 34, 58%), mental tiredness (n = 30, 51%), sleeping disorder (n = 24, 41%), headache (n = 23, 39%) and stress (n = 20, 34%). Twenty-six (44%) patients visited the GP with at least one issue. Patients who did consult their GP reported significantly more often muscle weakness (11 vs 3, p = 0.003) than patients who did not, which remained significant after correction for multiple testing, which was not the case for paralysis in hand/leg (10 vs 4), focussing (11 vs 6) or a change in awareness (9 vs 4).

CONCLUSIONS

Glioma patients experience a range of non-specific problems in the year prior to diagnosis, but only patients who consult the GP report more often neurological problems.

An Inflammatory Landscape for Preoperative Neurologic Deficits in Glioblastoma

Introduction: Patients with glioblastoma (GBM), one of the most aggressive forms of primary brain tumors, exhibit a wide range of neurologic signs, ranging from headaches to neurologic deficits and cognitive impairment, at first clinical presentation. While such variability is attributed to inter-individual differences in increased intracranial pressure, tumor infiltration, and vascular compromise, a direct association with disease stage, tumor size and location, edema, and necrotic cell death has yet to be established. The lack of specificity of neurologic symptoms often confounds the diagnosis of GBM. It also limits clinicians' ability to elect treatment regimens that not only prolong survival but also promote symptom management and high quality of life. Methods: To decipher the heterogeneous presentation of neurologic symptoms in GBM, we investigated differences in the molecular makeup of tumors from patients with and without preoperative neurologic deficits. We used the Ivy GAP (Ivy Glioblastoma Atlas Project) database to integrate RNA sequencing data from histologically defined GBM tumor compartments and neurologic examination records for 41 patients. We investigated the association of neurologic deficits with various tumor and patient attributes. We then performed differential gene expression and co-expression network analysis to identify a transcriptional signature specific to neurologic deficits in GBM. Using functional enrichment analysis, we finally provided a comprehensive and detailed characterization of involved pathways and gene interactions. Results: An exploratory investigation of the association of tumor and patient variables with the early development of neurologic deficits in GBM revealed a lack of robust and consistent clinicopathologic prognostic factors. We detected significant differences in the expression of 728 genes (FDR-adjusted p-value ≤ 0.05 and relative fold-change ≥ 1.5), unique to the cellular tumor (CT) anatomical compartment, between neurologic deficit groups. Upregulated differentially expressed genes in CT were enriched for mesenchymal subtype-predictive genes. Applying a systems approach, we then identified co-expressed gene sets that correlated with neurological deficit manifestation (FDR-adjusted p-value < 0.1). Collectively, these findings uncovered significantly enriched immune activation, oxidative stress response, and cytokine-mediated proinflammatory processes. Conclusion: Our study posits that inflammatory processes, as well as a mesenchymal tumor subtype, are implicated in the pathophysiology of preoperative neurologic deficits in GBM.

Effect of Gross Total Resection in World Health Organization Grade II Astrocytomas: SEER-Based Survival Analysis

INTRODUCTION

We sought to compare the survival benefit associated with gross total resection (GTR) in World Health Organization grade II astrocytomas (A2) with those of grade III (A3) and grade IV (glioblastoma) astrocytomas.

METHODS

Using the Surveillance, Epidemiology, and End Results program database (1999-2010), we identified 4113 A2 patients. Surgical resection was defined as GTR, subtotal resection (STR), or no resection. Kaplan-Meier and multivariate Cox proportional hazards analyses were used to assess survival with respect to extent of resection. Results were compared with the benefit of GTR over STR in 2755 A3 and 21,962 glioblastoma patients from the same database.

RESULTS

A multivariate Cox proportional hazards analysis indicated that A2 patients who underwent a GTR had a 28.3% reduction in the hazard of death relative to A2 patients who underwent STR. Similar risk reductions were observed in A2 patients age <50 and ≥50. However, because of differences in the natural history of these cohorts, the relative hazard reduction translated into distinct overall survival profiles. For A2 patients ≥50 years old, the GTR-associated survival benefit was approximately 6 months, resembling that observed in glioblastoma patients. In contrast, GTR in A2 patients <50 years old was associated with survival profiles superior to those observed in A3 patients.

CONCLUSIONS

In the Surveillance, Epidemiology, and End Results (SEER) program database, GTR-associated survival benefit in A2 patients ≥50 years old resembled that observed in glioblastoma, while GTR in A2 patients <50 years old was associated with a distinctly more favorable survival profile.