1
|
Xu H, Chen X, Sun Y, Hu X, Zhang X, Wang Y, Tang Q, Zhu Q, Song K, Chen H, Sheng X, Yao Y, Zhuang D, Chen L, Mao Y, Qin Z. Comprehensive molecular characterization of long-term glioblastoma survivors. Cancer Lett 2024; 593:216938. [PMID: 38734160 DOI: 10.1016/j.canlet.2024.216938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Fewer than 5 % glioblastoma (GBM) patients survive over five years and are termed long-term survivors (LTS), yet their molecular background is unclear. The present cohort included 72 isocitrate dehydrogenase (IDH)-wildtype GBM patients, consisting of 35 LTS and 37 short-term survivors (STS), and we employed whole exome sequencing, RNA-seq and DNA methylation array to delineate this largest LTS cohort to date. Although LTS and STS demonstrated analogous clinical characters and classical GBM biomarkers, CASC5 (P = 0.002) and SPEN (P = 0.013) mutations were enriched in LTS, whereas gene-to-gene fusions were concentrated in STS (P = 0.007). Importantly, LTS exhibited higher tumor mutation burden (P < 0.001) and copy number (CN) increase (P = 0.013), but lower mutant-allele tumor heterogeneity score (P < 0.001) and CN decrease (P = 0.026). Additionally, LTS demonstrated hypermethylated genome (P < 0.001) relative to STS. Differentially expressed and methylated genes both enriched in olfactory transduction. Further, analysis of the tumor microenvironment revealed higher infiltration of M1 macrophages (P = 0.043), B cells (P = 0.016), class-switched memory B cells (P = 0.002), central memory CD4+ T cells (P = 0.031) and CD4+ Th1 cells (P = 0.005) in LTS. We also separately analyzed a subset of patients who were methylation class-defined GBM, contributing 70.8 % of the entire cohort, and obtained similar results relative to prior analyses. Finally, we demonstrated that LTS and STS could be distinguished using a subset of molecular features. Taken together, the present study delineated unique molecular attributes of LTS GBM.
Collapse
Affiliation(s)
- Hao Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Xinyu Chen
- Department of Breast and Urologic Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ying Sun
- GenomiCare Biotechnology (Shanghai) Co. Ltd., Shanghai, China; Department of Data Science, Shanghai CreateCured Biotechnology Co. Ltd., Shanghai, China
| | - Xiaomu Hu
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xuan Zhang
- GenomiCare Biotechnology (Shanghai) Co. Ltd., Shanghai, China
| | - Ye Wang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Qisheng Tang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Qiongji Zhu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Kun Song
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Hong Chen
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaofang Sheng
- Department of Radiation Oncology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yu Yao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Dongxiao Zhuang
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
| | - Lingchao Chen
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
| | - Ying Mao
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
| | - Zhiyong Qin
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China; National Center for Neurological Disorders, Shanghai, China; Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China.
| |
Collapse
|
2
|
De la Cerda-Vargas MF, Pantalone MR, Söderberg Nauclér C, Medrano-Guzman R, Jauregui Renaud K, Nettel Rueda B, Reynoso-Sanchez MDJ, Lopez-Quintana B, Rodriguez-Florido MA, Feria-Romero IA, Trejo-Rosales RR, Arreola-Rosales RL, Candelas-Rangel JA, Navarro-Dominguez P, Meza-Mata E, Muñoz- Hernandez MA, Segura-Lopez F, Gonzalez-Martinez MDR, Delgado-Aguirre HA, Sandoval-Bonilla BA. Focal-to-bilateral tonic-clonic seizures and High-grade CMV-infection are poor survival predictors in Tumor-related Epilepsy Adult-type diffuse gliomas-A single-center study and literature review. Heliyon 2024; 10:e28555. [PMID: 38623248 PMCID: PMC11016600 DOI: 10.1016/j.heliyon.2024.e28555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
Introduction Previous studies have reported a correlation between a high-grade CMV-infection and an unfavorable prognosis in glioblastoma (GB). Coversely, epilepsy has been associated with a more favorable outcome in GB patients. Despites epilepsy and CMV share similar molecular mechanisms in GB tumoral microenvironment, the correlation between Tumor-Related-Epilepsy (TRE) and CMVinfection remains unexplored. The aim of our study is to examine the correlation between the dregree of CMV infection and seizure types on the survival of TRE Adult-type-diffuse-glioma. To achieve this objective, we conducted a comprehensive literature review to assess our results regarding previous publications. Methods We conducted a retrospective-observational study on TRE Adult-type-diffuse-gliomas treated at a single center in Mexico from 2010 to 2018. Tumor tissue and cDNA were analyzed by immunochemistry (IHC) for CMV (IE and LA antigens) at the Karolinska Institute in Sweden, and RT-PCR for CMV-gB in Torreon Mexico, respectively. Bivariate analysis (X2-test) was performed to evaluate the association between subtypes of Adult-type-diffuse-glioma (IDH-mut grade 4 astrocytoma vs. IDH-wt glioblastoma) and the following variables: type of hemispheric involvement (mesial vs. neocortical involvement), degree of CMV infection (<25%vs. >25% infected-tumoral cells) and seizure types [Focal awareness, focal impaired awareness, and FBTCS]. Kaplan Meier and Cox analyses were performed to determine the risk, p < 0.05 was considered statistically significant. Results Sixty patients with TRE Adult type diffuse gliomas were included (80% IDH-wt glioblastoma and 20% IDH-mut grade 4astrocytomas). The mean age was 61.5 SD ± 18.4, and 57% were male. Fifty percent of the patients presented with mesial involvement of the hemysphere. Seizure types included focal awareness (15%), focal impaired awareness (43.3%), and FBTCS (41.7%). Ninety percent of cases were treated with Levetiracetam and 33.3% presented Engel-IA postoperative seizure control. More than 90% of samples were positive for CMV-immunohistochemistry (IHC). However, all cDNA analyzed by RT-PCR return negative results. The median of overall survival (OS) was 15 months. High-grade CMV-IE infection (14 vs. 25 months, p<0.001), mesial involvement (12 vs. 18 months, p<0.001), and FBTCS were associated with worse OS (9 vs.18 months for non-FBTCS). Multivariate analysis demonstrated that high-grade CMV infection (HR = 3.689, p=0.002) and FBTCS (HR=7.007, p<0.001) were independent unfavorable survival factors. Conclusions CMV induces a proinflammatory tumoral microenvironment that contributes to the developmet of epilepsy. Tumor progression could be associated not only with a higher degree of CMV infection but also to epileptogenesis, resulting in a seizure phenotype chracterized by FBTCS and poor survival outcomes. This study represents the first survival analysis in Latin America to include a representative sample of TRE Adult-type diffuse gliomas considering CMV-infection-degree and distinguishing features (such as FBTCS) that might have potential clinical relevance in this group of patients. Further prospective studies are required to validate these results.
Collapse
Affiliation(s)
- Maria F. De la Cerda-Vargas
- Department of Neurosurgery and Neurotechnology, Universitätsklinik Tübingen, Tübingen, Germany
- Department of Neurosurgery, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon Coahuila, Mexico
| | - Mattia Russel Pantalone
- Department of Medicine, Solna, BioClinicum, Karolinska Institutet, 171 64, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, 171 76, Stockholm, Sweden
| | - Cecilia Söderberg Nauclér
- Department of Medicine, Solna, BioClinicum, Karolinska Institutet, 171 64, Stockholm, Sweden
- Department of Biosciences at the University of Turku, InFLAMES Research Flagship Center, MediCity, University of Turku, Finland
| | - Rafael Medrano-Guzman
- Department of Sarcomas, Oncology Hospital, High Specialty Medical Unit (UMAE), National Medical Center, IMSS, Mexico City, Mexico
| | - Kathrine Jauregui Renaud
- Medical Research Unit in Otoneurology, Mexican Institute of Social Security, Mexico City, 06720, Mexico
| | - Barbara Nettel Rueda
- Department of Neurosurgery, Hospital de Especialidades, Centro Médico Nacional (CMN) Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Ma de Jesus Reynoso-Sanchez
- Department of Neuroanesthesiology, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico, 06720
| | - Brenda Lopez-Quintana
- Department of Neuroanesthesiology, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico, 06720
| | | | - Iris A. Feria-Romero
- Medical Research Unit in Neurological Diseases, Specialties Hospital, National Medical Center Siglo XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Rogelio R. Trejo-Rosales
- Medical Oncology, Hospital de Oncología, Centro Medico Nacional Siglo XXI, Instituto Mexicano Del Seguro Social, Mexico City, 06720, Mexico
| | | | - Jose A. Candelas-Rangel
- Department of Neurosurgery, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon Coahuila, Mexico
| | - Pedro Navarro-Dominguez
- Department of Neurosurgery, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon Coahuila, Mexico
| | - Elizabeth Meza-Mata
- Department of Pathology, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreon, Coahuila, Mexico
| | - Melisa A. Muñoz- Hernandez
- Department of Health and Research, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - F.K. Segura-Lopez
- Department of Health and Research, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | | | - Hector A. Delgado-Aguirre
- Department of Transplants, Medical Specialties Hospital No. 71, Instituto Mexicano del Seguro Social, Torreón, Coahuila, Mexico
| | - Bayron A. Sandoval-Bonilla
- Department of Neurosurgery, Epilepsy Surgery Multidisciplinary Board, Functional NeuroOncology Clinic, CMN Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, 06720, Mexico
| |
Collapse
|
3
|
Estevez-Ordonez D, Abdelrashid M, Coffee E, Laskay NMB, Atchley TJ, Chkheidze R, Fiveash JB, Markert JM, Lobbous M, Maveal BM, Burt Nabors L. Racial and socioeconomic disparities in glioblastoma outcomes: A single-center, retrospective cohort study. Cancer 2023; 129:3010-3022. [PMID: 37246417 DOI: 10.1002/cncr.34881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/08/2023] [Accepted: 04/24/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Glioblastoma (GBM) is the most common malignant primary brain tumor. Emerging reports have suggested that racial and socioeconomic disparities influence the outcomes of patients with GBM. No studies to date have investigated these disparities controlling for isocitrate dehydrogenase (IDH) mutation and O-6-methylguanine-DNA methyltransferase (MGMT) status. METHODS Adult patients with GBM were retrospectively reviewed at a single institution from 2008 to 2019. Univariable and multivariable complete survival analyses were performed. A Cox proportional hazards model was used to assess the effect of race and socioeconomic status controlling for a priori selected variables with known relevance to survival. RESULTS In total, 995 patients met inclusion criteria. Of these, 117 patients (11.7%) were African American (AA). The median overall survival for the entire cohort was 14.23 months. In the multivariable model, AA patients had better survival compared with White patients (hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.2-0.69). The observed survival difference was significant in both a complete case analysis model and a multiple imputations model accounting for missing molecular data and controlling for treatment and socioeconomic status. AA patients with low income (HR, 2.17; 95% CI, 1.04-4.50), public insurance (HR, 2.25; 95% CI, 1.04-4.87), or no insurance (HR, 15.63; 95% CI, 2.72-89.67) had worse survival compared with White patients with low income, public insurance, or no insurance, respectively. CONCLUSIONS Significant racial and socioeconomic disparities were identified after controlling for treatment, GBM genetic profile, and other variables associated with survival. Overall, AA patients demonstrated better survival. These findings may suggest the possibility of a protective genetic advantage in AA patients. PLAIN LANGUAGE SUMMARY To best personalize treatment for and understand the causes of glioblastoma, racial and socioeconomic influences must be examined. The authors report their experience at the O'Neal Comprehensive Cancer Center in the deep south. In this report, contemporary molecular diagnostic data are included. The authors conclude that there are significant racial and socioeconomic disparities that influence glioblastoma outcome and that African American patients do better.
Collapse
Affiliation(s)
| | - Moaaz Abdelrashid
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Coffee
- Division of Neuro-Oncology, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Nicholas M B Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Travis J Atchley
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Rati Chkheidze
- Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John B Fiveash
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James M Markert
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Mina Lobbous
- School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Brandon M Maveal
- Division of Neuropathology, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Louis Burt Nabors
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Division of Neuro-Oncology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
4
|
Das S, Mishra RK, Agrawal A. Prognostic factors affecting outcome of multifocal or multicentric glioblastoma: A scoping review. J Neurosci Rural Pract 2023; 14:199-209. [PMID: 37181186 PMCID: PMC10174113 DOI: 10.25259/jnrp_41_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022] Open
Abstract
It has been reported that patients with multiple lesions have shorter overall survival compared to single lesion in glioblastoma (GBM). Number of lesions can profoundly impact the prognosis and treatment outcome in GBM. In view of the advancement of imaging, multiple GBM (mGBM) lesions are increasingly recognized and reported. The scoping review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension statement for systematic review. Database was searched to collect relevant articles based on predefined eligibility criteria. Our observations suggest that multifocal/multicentric GBM has poorer outcome compared to GBM with singular lesion (sGBM). As the factors influencing the prognosis and outcome is poorly understood and there is no consensus in the existing literature, this review is clinically relevant. As patients with single lesion are more likely to undergo gross total excision, it is likely that further adjuvant treatment may be decided by extent of resection. This review will be helpful for design of further prospective randomized studies for optimal management of mGBM.
Collapse
Affiliation(s)
- Saikat Das
- Department of Radiation Oncology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Rakesh Kumar Mishra
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|
5
|
Refining Glioblastoma Surgery through the Use of Intra-Operative Fluorescence Imaging Agents. Pharmaceuticals (Basel) 2022; 15:ph15050550. [PMID: 35631376 PMCID: PMC9143023 DOI: 10.3390/ph15050550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/22/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Glioblastoma (GBM) is the most aggressive adult brain tumour with a dismal 2-year survival rate of 26–33%. Maximal safe resection plays a crucial role in improving patient progression-free survival (PFS). Neurosurgeons have the significant challenge of delineating normal tissue from brain tumour to achieve the optimal extent of resection (EOR), with 5-Aminolevulinic Acid (5-ALA) the only clinically approved intra-operative fluorophore for GBM. This review aims to highlight the requirement for improved intra-operative imaging techniques, focusing on fluorescence-guided imaging (FGS) and the use of novel dyes with the potential to overcome the limitations of current FGS. The review was performed based on articles found in PubMed an.d Google Scholar, as well as articles identified in searched bibliographies between 2001 and 2022. Key words for searches included ‘Glioblastoma’ + ‘Fluorophore’+ ‘Novel’ + ‘Fluorescence Guided Surgery’. Current literature has favoured the approach of using targeted fluorophores to achieve specific accumulation in the tumour microenvironment, with biological conjugates leading the way. These conjugates target specific parts overexpressed in the tumour. The positive results in breast, ovarian and colorectal tissue are promising and may, therefore, be applied to intracranial neoplasms. Therefore, this design has the potential to produce favourable results in GBM by reducing the residual tumour, which translates to decreased tumour recurrence, morbidity and ultimately, mortality in GBM patients. Several preclinical studies have shown positive results with targeted dyes in distinguishing GBM cells from normal brain parenchyma, and targeted dyes in the Near-Infrared (NIR) emission range offer promising results, which may be valuable future alternatives.
Collapse
|
6
|
Battista F, Muscas G, Dinoi F, Gadda D, Della Puppa A. Ventricular entry during surgical resection is associated with intracranial leptomeningeal dissemination in glioblastoma patients. J Neurooncol 2022; 160:473-480. [PMID: 36273377 PMCID: PMC9722854 DOI: 10.1007/s11060-022-04166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 10/12/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Glioblastoma (GBM) is associated with a poorer prognosis when leptomeningeal dissemination (LMD) occurs. Recently, the role of both ventricular entry (VE) during surgery and subventricular zone localization of tumors in promoting LMD in GBM patients has been debated. This article investigates the role of VE in causing LMD in GBM patients. METHODS We conducted a retrospective analysis of GBMs operated on at our Institution between March 2018 and December 2020. We collected pre- and post-surgical images, anamnestic information, and surgical reports. RESULTS Two hundred cases were collected. The GBM localization was periventricular in 69.5% of cases, and there was a VE during the surgical procedure in 51% of cases. The risk of post-surgical LMD in the case of VE was 16%. The rate of LMD was higher in the case of VE than not-VE (27.4% vs. 4%, p < 0.0001). The rate of LMD in periventricular GBM was 19% (p = 0.1131). CONCLUSION According to our data, VE is an independent factor associated with a higher rate of post-surgical LMD, and the periventricular localization is not independently correlated to this negative outcome. Neurosurgeons should avoid VE when possible. The correct surgical strategy should be founded on balancing the need for maximal EOR and the risks associated with VE.
Collapse
Affiliation(s)
- Francesca Battista
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Largo Palagi 1, 50137 Florence, Italy
| | - Giovanni Muscas
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Largo Palagi 1, 50137 Florence, Italy
| | - Francesca Dinoi
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Largo Palagi 1, 50137 Florence, Italy
| | - Davide Gadda
- Department of Neuro-Radiology, Careggi Hospital and University of Florence, Florence, Italy
| | - Alessandro Della Puppa
- Department of Neurosurgery, Department of Neuroscience, Psychology, Drug Area and Child Health (NEUROFARBA), Careggi University Hospital, University of Florence, Largo Palagi 1, 50137 Florence, Italy
| |
Collapse
|
7
|
Wang R, Song Y, Hu T, Wang X, Jiang Y, Zhang D, Yu J, Han S, Kan L. Decreased CD8 + Lymphocytic Infiltration in Multifocal and Multicentric Glioblastomas. Front Oncol 2021; 11:748277. [PMID: 34646781 PMCID: PMC8503598 DOI: 10.3389/fonc.2021.748277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Multifocal and multicentric glioblastomas (mGBMs) are associated with a poorer prognosis compared to unifocal glioblastoma (uGBM). The presence of CD8+ tumor-infiltrating lymphocytes (TILs) is predictive of clinical outcomes in human malignancies. Here, we examined the CD8+ lymphocytic infiltration in mGBMs. Methods The clinical data of 57 consecutive IDH wildtype primary mGBM patients with histopathological diagnoses were retrospectively reviewed. CD8+ TILs were quantitatively evaluated by immunohistochemical staining. The survival function of CD8+ TILs was assessed by Kaplan–Meier analysis and Cox proportional hazard models. Results No significant difference in the concentration of CD8+ TILs was observed among foci from the same patient (P>0.150). The presence of CD8+ TILs was similar between multifocal and multicentric GBMs (P=0.885). The concentration of CD8+ TILs was significantly lower in mGBMs than in uGBMs (P=0.002). In mGBM patients, the CD8+ TIL level was associated with preoperative KPS (P=0.018). The median overall survival (OS) of the 57 mGBMs was 9 months. A low CD8+ TIL level (multivariate HR 4.404, 95% CI 1.954-9.926, P=0.0004) was an independent predictor of poor OS, while postoperative temozolomide chemotherapy (multivariate HR 6.076, 95% CI 2.330-15.842, P=0.0002) was independently associated with prolonged OS in mGBMs. Conclusions Decreased CD8+ TIL levels potentially correlate with unfavorable clinical outcome in mGBMs, suggesting an influence of the local immuno-microenvironment on the progression of mGBMs.
Collapse
Affiliation(s)
- Run Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China.,Department of Neurosurgery, Huazhong University of Science and Technology Union Shenzhen Hospital (Nanshan Hospital), Shenzhen, China
| | - Yifu Song
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Tianhao Hu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Xiaoliang Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Yang Jiang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China.,Department of Neurosurgery, Shanghai First People's Hospital of Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Di Zhang
- Department of Pathology, China Medical University, Shenyang, China
| | - Juanhan Yu
- Department of Pathology, China Medical University, Shenyang, China
| | - Sheng Han
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, China
| | - Liang Kan
- Department of Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
8
|
Red blood cell distribution width to platelet ratio substantiates preoperative survival prediction in patients with newly-diagnosed glioblastoma. J Neurooncol 2021; 154:229-235. [PMID: 34347223 PMCID: PMC8437903 DOI: 10.1007/s11060-021-03817-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
Object The conception of individual patient-adjusted treatment strategies is constantly emerging in the field of neuro-oncology. Systemic laboratory markers may allow insights into individual needs and estimated treatment benefit at an earliest possible stage. Therefore, the present study was aimed at analyzing the prognostic significance of preoperative routine laboratory values in patients with newly-diagnosed glioblastoma. Methods Between 2014 and 2019, 257 patients were surgically treated for newly-diagnosed glioblastoma at the Neuro-Oncology Center of the University Hospital Bonn. Preoperative routine laboratory values including red blood cell distribution width (RDW) and platelet count were reviewed. RDW to platelet count ratio (RPR) was calculated and correlated to overall survival (OS) rates. Results Median preoperative RPR was 0.053 (IQR 0.044–0.062). The receiver operating characteristic (ROC) curve indicated an optimal cut-off value for RPR to be 0.05 (AUC 0.62; p = 0.002, 95% CI 0.544–0.685). 101 patients (39%) presented with a preoperative RPR < 0.05, whereas 156 patients (61%) had a RPR ≥ 0.05. Patients with preoperative RPR < 0.05 exhibited a median OS of 20 months (95% CI 17.9–22.1), which was significantly higher compared to a median OS of 13 months (95% CI 10.9–15.1) in patients with preoperative RPR ≥ 0.05 (p < 0.001). Conclusions The present study suggests the RPR to constitute a novel prognostic inflammatory marker for glioblastoma patients in the course of preoperative routine laboratory examinations and might contribute to a personalized medicine approach.
Collapse
|
9
|
Efendioğlu M, Şanli E, Türkoğlu C, Balak N. Reduced Serum sRANKL and sTREM2 Levels in High-Grade Gliomas: Association with Prognosis. Noro Psikiyatr Ars 2021; 58:133-136. [PMID: 34188596 PMCID: PMC8214753 DOI: 10.29399/npa.27536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/07/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION High-grade gliomas (HGG), including Glioblastoma multiforme (GBM), account for the majority of primary brain tumors. Nevertheless, prognostic and diagnostic biomarkers are quite limited for HGG. The objective of this study was to investigate the prognostic value of sRANKL and sTREM2 levels in HGG patients. METHODS Twelve consecutive patients with HGG, 14 patients with non-glial tumors (non-GT) and 20 age and gender-matched healthy controls were recruited. Overall survival duration of the patients was recorded. Pre-operative serum levels of sRANKL and sTREM2 were measured by ELISA. Tumors of HGG patients were analyzed by immunohistochemical staining for p53 and Ki67 and percentage scores were calculated. RESULTS Patients with HGG and non-GT showed lower serum sRANKL and sTREM2 levels than healthy individuals. Levels of sRANKL were inversely correlated with the overall survival of patients (p=0.002, R=0.787), while sTREM2 levels were inversely correlated with p53 score (p=0.018, R=-0.666) but not survival. CONCLUSION Brain tumor patients show suppressed levels of glial activity biomarkers in the peripheral circulation. Serum sRANKL levels may serve as a potential prognostic biomarker for HGG.
Collapse
Affiliation(s)
- Mustafa Efendioğlu
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Elif Şanli
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | | | - Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
10
|
On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI. ACTA ACUST UNITED AC 2021; 28:1437-1446. [PMID: 33917207 PMCID: PMC8167648 DOI: 10.3390/curroncol28020136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/28/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
Primary glioblastoma (GBM), IDH-wildtype, especially with multifocal appearance/growth (mGBM), is associated with very poor prognosis. Several clinical parameters have been identified to provide prognostic value in both unifocal GBM (uGBM) and mGBM, but information about the influence of radiological parameters on survival for mGBM cohorts is scarce. This study evaluated the prognostic value of several volumetric parameters derived from magnetic resonance imaging (MRI). Data from the Department of Neurosurgery, Leipzig University Hospital, were retrospectively analyzed. Patients treated between 2014 and 2019, aged older than 18 years and with adequate peri-operative MRI were included. Volumetric assessment was performed manually. One hundred and eighty-three patients were included. Survival of patients with mGBM was significantly shorter (p < 0.0001). Univariate analysis revealed extent of resection, adjuvant therapy regimen, residual tumor volume, tumor necrosis volume and ratio of tumor necrosis to initial volume as statistically significant for overall survival. In multivariate Cox regression, however, only EOR (for uGBM and the entire cohort) and adjuvant therapy were independently significant for survival. Decreased ratio of tumor necrosis to initial tumor volume and extent of resection were associated with prolonged survival in mGBM but failed to achieve statistical significance in multivariate analysis.
Collapse
|
11
|
Patel SH, Batchala PP, Muttikkal TJE, Ferrante SS, Patrie JT, Fadul CE, Schiff D, Lopes MB, Jain R. Fluid attenuation in non-contrast-enhancing tumor (nCET): an MRI Marker for Isocitrate Dehydrogenase (IDH) mutation in Glioblastoma. J Neurooncol 2021; 152:523-531. [PMID: 33661425 DOI: 10.1007/s11060-021-03720-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The WHO 2016 update classifies glioblastomas (WHO grade IV) according to isocitrate dehydrogenase (IDH) gene mutation status. We aimed to determine MRI-based metrics for predicting IDH mutation in glioblastoma. METHODS This retrospective study included glioblastoma cases (n = 199) with known IDH mutation status and pre-operative MRI (T1WI, T2WI, FLAIR, contrast-enhanced T1W1 at minimum). Two neuroradiologists determined the following MRI metrics: (1) primary lobe of involvement (frontal or non-frontal); (2) presence/absence of contrast-enhancement; (3) presence/absence of necrosis; (4) presence/absence of fluid attenuation in the non-contrast-enhancing tumor (nCET); (5) maximum width of peritumoral edema (cm); (6) presence/absence of multifocal disease. Inter-reader agreement was determined. After resolving discordant measurements, multivariate association between consensus MRI metrics/patient age and IDH mutation status was determined. RESULTS Among 199 glioblastomas, 16 were IDH-mutant. Inter-reader agreement was calculated for contrast-enhancement (ĸ = 0.49 [- 0.11-1.00]), necrosis (ĸ = 0.55 [0.34-0.76]), fluid attenuation in nCET (ĸ = 0.83 [0.68-0.99]), multifocal disease (ĸ = 0.55 [0.39-0.70]), and primary lobe (ĸ = 0.85 [0.80-0.91]). Mean difference for peritumoral edema width between readers was 0.3 cm [0.2-0.5], p < 0.001. Multivariate analysis uncovered significant associations between IDH-mutation and fluid attenuation in nCET (OR 82.9 [19.22, ∞], p < 0.001), younger age (OR 0.93 [0.86, 0.98], p = 0.009), frontal lobe location (OR 11.08 [1.14, 352.97], p = 0.037), and less peritumoral edema (OR 0.15 [0, 0.65], p = 0.044). CONCLUSIONS Conventional MRI metrics and patient age predict IDH-mutation status in glioblastoma. Among MRI markers, fluid attenuation in nCET represents a novel marker with high inter-reader agreement that is strongly associated with Glioblastoma, IDH-mutant.
Collapse
Affiliation(s)
- Sohil H Patel
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA.
| | - Prem P Batchala
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Thomas J Eluvathingal Muttikkal
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - Sergio S Ferrante
- Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, Charlottesville, VA, 22908, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia Health System, Charlottesville, VA, USA
| | - Camilo E Fadul
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - David Schiff
- Division of Neuro-Oncology, Department of Neurology, University of Virginia Health System, Charlottesville, VA, USA
| | - M Beatriz Lopes
- Department of Pathology, Divisions of Neuropathology and Molecular Diagnostics, University of Virginia Health System, Charlottesville, VA, USA
| | - Rajan Jain
- Department of Radiology, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA.,Department of Neurosurgery, New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| |
Collapse
|
12
|
Alimohammadi E, Bagheri SR, Sadeghsalehi A, Rizevandi P, Rezaie Z, Abdi A. Prognostic factors in patients with glioblastoma multiforme: focus on the pathologic variants. Acta Neurol Belg 2020; 120:1341-1350. [PMID: 31222512 DOI: 10.1007/s13760-019-01171-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/11/2019] [Indexed: 12/16/2022]
Abstract
The aim of this study was to offer predicting factors for survival in adult patients with glioblastoma multiforme. 153 consecutive patients with high-grade glioma (WHO grade IV) were studied in Imam Reza hospital, Kermanshah University of Medical Science, Kermanshah, Iran, between April 2003 and April 2017. All patients treated with surgical resection and standard postoperative radiotherapy (54 Gy). Using the patients' charts and electronic medical records system, the following data were obtained: gender, age, Karnofsky performance status (KPS) score on admission, primary vs. secondary type, extent of surgery, tumor location, tumor size, necrosis size, use of Temozolomide (TMZ), pathology subtype, and immunohistochemistry results. Patients were followed from the time of the surgery until the death occurred. Overall survival (OS) and progression-free survival (PFS) were calculated by the Kaplan-Meier method. Survival time curves for various subgroups were compared by the log-rank test. The impact of the suggested prognostic factors on survival was evaluated by univariate and multivariate analyses. Age, gender, KPS, extent of surgery, tumor location, necrosis size, and reoperation in recurrence had not any statistically significant effect on survival. Univariate analysis revealed a significant impact on outcome for pathology subtype (PFS: P < 0.001, OS: P < 0.001), tumor type (primary vs. secondary) (PFS: P = P < 0.001, OS: P < 0.001), tumor size (PFS: P = 0.044, OS: P = 0.04), TMZ therapy (PFS: P < 0.001, OS: P < 0.001), P53 (PFS: P < 0.001, OS: P < 0.001), and Ki67 (PFS: P < 0.001, OS: P < 0.001). In multivariate analysis, independent favorable prognostic factors for survival were pathology subtype (PFS: P < 0.001, OS: P < 0.001), type (PFS: P < 0.001, OS: 0.012), TMZ (PFS: P < 0.001, OS: P < 0.001), P53 (PFS: P < 0.001, OS: P < 0.001), and Ki67 (PFS: P < 0.001, OS: P < 0.001). The results suggest that pathology subtype, primary vs. secondary type, TMZ therapy, P53, and Ki 63 may play an important role in the survival of patients with glioblastoma multiforme. There is no relationship detected between age, gender, KPS, tumor size and location, necrosis size, extent of surgery, reoperation in recurrence, and patient survival.
Collapse
Affiliation(s)
- Ehsan Alimohammadi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Seyed Reza Bagheri
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Parisa Rizevandi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Zahra Rezaie
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
13
|
Gan C, Pierscianek D, El Hindy N, Ahmadipour Y, Keyvani K, Sure U, Zhu Y. The predominant expression of cancer stem cell marker ALDH1A3 in tumor infiltrative area is associated with shorter overall survival of human glioblastoma. BMC Cancer 2020; 20:672. [PMID: 32680476 PMCID: PMC7368792 DOI: 10.1186/s12885-020-07153-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022] Open
Abstract
Background ALDH1A3 is a cancer stem cell marker in neoplasms including glioblastoma (GBM). However, the comprehensive role of ALDH1A3 in GBM remains unclear. This study attempted to investigate the expression of ALDH1A3 in human GBM tissues and its association with clinical parameters. Methods Thirty primary GBM and 9 control were enrolled in this study. ALDH1A3 mRNA and protein expression levels were detected by RT2-PCR and western blot, respectively. Immunohistochemistry and immunofluorescence staining were performed to evaluate the regional and cellular expression manner of ALDH1A3. The association of ALDH1A3 expression with multiple clinical parameters was analyzed. Results ALDH1A3 protein level, but not mRNA level, in a subgroup of GBM was significantly higher than that in the control group. ALDH1A3 immunoreactivity was detected heterogeneously in individual GBMs. Fifteen of 30 cases showed a positive of ALDH1A3 immunoreactivity which was predominantly observed in the tumor infiltrative area (TI). Double immunofluorescence staining revealed a co-localization of ALDH1A3 with GFAP in glial-shaped cells and in tumor cells. ALDH1A3 immunoreactivity was often merged with CD44, but not with CD68. Moreover, ALDH1A3 expression was positively associated with the tumor edema grade and inversely with overall survival (OS) (median OS: 16 months vs 10 months), but with neither MGMT promoter methylation status nor Ki67 index in GBM. An upregulation of ALDH1A3 was accompanied by a reduced expression of STAT3β and p-STAT3β. Conclusions Inter- and intra-tumoral heterogeneous expression of ALDH1A3 was exhibited in GBMs. A high immunoreactivity of ALDH1A3 in tumor infiltrative area was associated with shorter OS, especially in patients with MGMT promoter methylation. Our findings propose ALDH1A3 not only as a predictive biomarker but also as a potential target for personalized therapy of GBM.
Collapse
Affiliation(s)
- Chao Gan
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.,Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Daniela Pierscianek
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Nicolai El Hindy
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.,Present Address: Department of Spine- and Peripheral Nerve-Surgery, St. Christophorus 625 Hospital, Werne, Germany
| | - Yahya Ahmadipour
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery and Spine Surgery, University hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| |
Collapse
|
14
|
Improved 3-year survival rates for glioblastoma multiforme are associated with trends in treatment: analysis of the national cancer database from 2004 to 2013. J Neurooncol 2020; 148:69-79. [DOI: 10.1007/s11060-020-03469-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/23/2020] [Indexed: 12/22/2022]
|
15
|
Ahmadipour Y, Rauschenbach L, Gembruch O, Darkwah Oppong M, Michel A, Pierscianek D, Stuschke M, Glas M, Sure U, Jabbarli R. To resect or not to resect? Risks and benefits of surgery in older patients with glioblastoma. J Geriatr Oncol 2020; 11:688-693. [DOI: 10.1016/j.jgo.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/28/2019] [Accepted: 10/16/2019] [Indexed: 01/20/2023]
|
16
|
Pierscianek D, Ahmadipour Y, Kaier K, Darkwah Oppong M, Michel A, Kebir S, Stuschke M, Glas M, Sure U, Jabbarli R. The SHORT Score for Preoperative Assessment of the Risk for Short-Term Survival in Glioblastoma. World Neurosurg 2020; 138:e370-e380. [PMID: 32145416 DOI: 10.1016/j.wneu.2020.02.131] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite recent improvements in treatment of glioblastoma (GBM), some patients still have a short survival. We sought to develop a new risk score for preoperative assessment of short-term survival (STS) (<6 months) in patients with GBM. METHODS All adult patients who underwent surgical resection of GBM between 2004 and 2014 were included (N = 379). Demographic and clinical parameters, which were available at admission, were assessed. Variables were evaluated in univariate and multivariate analyses. The score was validated in a separate cohort of patients with GBM who underwent surgical resection between 2015 and 2018. RESULTS The following independent predictors of STS were integrated into a new score: body height (<169 cm, 1 point), arterial hypertension (1 point), age (≤54 years, 0 points; 55-74 years, 1 points; ≥75 years, 2 points), and poor clinical status (Karnofsky performance scale [KPS] score: ≤60%, 2 points; 70%-80%, 1 point; ≥90%, 0 points). The new risk score, SHORT (Small body height, Hypertension, Older age, Reduced KPS score, short-Term survival), ranged from 0 to 6 points and showed good accuracy of risk estimation for STS in GBM (area under the curve: 0.715). STS rates were 9.7%, 23.1%, and 70% in patients with GBM scoring <2 points, 2-4 points, and >4 points (P < 0.0001). The score was successfully validated (area under the curve: 0.770). CONCLUSIONS This study presents the SHORT score for preoperative assessment of STS risk in patients with GBM. This risk score needs external validation in larger patient cohorts from other institutions. Our score might be a tool to facilitate treatment decisions in patients with GBM before surgery.
Collapse
Affiliation(s)
- Daniela Pierscianek
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany.
| | - Yahya Ahmadipour
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Klaus Kaier
- Institute for Medical Biometry and Medical Informatics, University Medical Center Freiburg, Freiburg, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Anna Michel
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Sied Kebir
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Martin Stuschke
- Department of Radiotherapy, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Martin Glas
- Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany; German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany
| |
Collapse
|
17
|
Ius T, Pignotti F, Della Pepa GM, La Rocca G, Somma T, Isola M, Battistella C, Gaudino S, Polano M, Dal Bo M, Bagatto D, Pegolo E, Chiesa S, Arcicasa M, Olivi A, Skrap M, Sabatino G. A Novel Comprehensive Clinical Stratification Model to Refine Prognosis of Glioblastoma Patients Undergoing Surgical Resection. Cancers (Basel) 2020; 12:cancers12020386. [PMID: 32046132 PMCID: PMC7072471 DOI: 10.3390/cancers12020386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/29/2020] [Accepted: 02/05/2020] [Indexed: 12/14/2022] Open
Abstract
Despite recent discoveries in genetics and molecular fields, glioblastoma (GBM) prognosis still remains unfavorable with less than 10% of patients alive 5 years after diagnosis. Numerous studies have focused on the research of biological biomarkers to stratify GBM patients. We addressed this issue in our study by using clinical/molecular and image data, which is generally available to Neurosurgical Departments in order to create a prognostic score that can be useful to stratify GBM patients undergoing surgical resection. By using the random forest approach [CART analysis (classification and regression tree)] on Survival time data of 465 cases, we developed a new prediction score resulting in 10 groups based on extent of resection (EOR), age, tumor volumetric features, intraoperative protocols and tumor molecular classes. The resulting tree was trimmed according to similarities in the relative hazard ratios amongst groups, giving rise to a 5-group classification tree. These 5 groups were different in terms of overall survival (OS) (p < 0.000). The score performance in predicting death was defined by a Harrell’s c-index of 0.79 (95% confidence interval [0.76–0.81]). The proposed score could be useful in a clinical setting to refine the prognosis of GBM patients after surgery and prior to postoperative treatment.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
- Correspondence: or ; Tel.: 0039-347-0178730/0039-0432
| | - Fabrizio Pignotti
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
| | | | - Giuseppe La Rocca
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| | - Teresa Somma
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, 80131 Naples, Italy;
| | - Miriam Isola
- Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (M.I.); (C.B.)
| | - Claudio Battistella
- Department of Medicine, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy; (M.I.); (C.B.)
| | - Simona Gaudino
- Institute of radiology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Maurizio Polano
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (M.P.); (M.D.B.)
| | - Michele Dal Bo
- Experimental and Clinical Pharmacology Unit, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy; (M.P.); (M.D.B.)
| | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging ASUIUD Udine, 33100 Udine, Italy;
| | - Enrico Pegolo
- Institute of Pathology, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Silvia Chiesa
- Radiation Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
| | - Mauro Arcicasa
- Department of Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, 33081 Aviano, Italy;
| | - Alessandro Olivi
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| | - Miran Skrap
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy;
| | - Giovanni Sabatino
- Department of Neurosurgery, Mater Olbia Hospital, 07026 Olbia, Italy; (F.P.); (G.S.); (G.L.R.)
- Institute of Neurosurgery, Catholic University, 00168 Rome, Italy; (G.M.D.P.); (A.O.)
| |
Collapse
|
18
|
Ius T, Pignotti F, Della Pepa GM, Bagatto D, Isola M, Battistella C, Gaudino S, Pegolo E, Chiesa S, Arcicasa M, La Rocca G, Olivi A, Skrap M, Sabatino G. Glioblastoma: from volumetric analysis to molecular predictors. J Neurosurg Sci 2020; 66:173-186. [PMID: 32031360 DOI: 10.23736/s0390-5616.20.04850-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite decades of therapeutic and molecular refinements, the prognosis of patients with glioblastoma (GBM) still remains unfavorable. Integrative clinical studies allow a better understanding of the natural evolution of GBM. To assess independent predictors of overall survival (OS) and progression free survival (PFS) clinical, surgical, molecular and radiological variables were evaluated. A novel preoperative volumetric magnetic resonance imaging (MRI) index for tumor prognosis in GBM patients was investigated. METHODS A cohort of 195 cases of patients operated for newly GBM were analyzed. Extent of tumoral resection (EOR), tumor growth pattern, expressed by preoperative volumetric ΔT1-T2 MRI index, molecular markers such as O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase 1/2 (IDH1/2) mutation, were analyzed. Analysis of survival was done using Cox-proportional hazard models. RESULTS The 1-, 2- years estimated OS and PFS rate for the whole population were 61% and 27%, 38% and 17%, respectively. A better survival rate, both in terms of survival and tumor progression, was observed in patient with higher EOR (p=0.000), younger age (p=0.000), MGMT methylation status (p=0.001) and lower preoperative ΔT1-T2 MRI index (p=0.004). Regarding the tumor growth pattern a cut-off value of 0.75 was found to discriminate patient with different prognosis. Patients with a preoperative ΔT1-T2 MRI index <0.75 had a 1-year estimated OS of 67%, otherwise patients with a preoperative ΔT1-T2 MRI index >0.75 hada 1-year estimated OS of 34%. CONCLUSIONS In this investigation longer survival is associated with younger age, EOR, promoter methylation of MGMT and preoperative tumor volumetric features expressed by ΔT1-T2 MRI index. The preoperative ΔT1-T2 MRI index could be a promising prognostic factor potentially useful in GBM management. Future investigations based on multiparametric MRI data and next generation sequences analysis, may better clarify this result.
Collapse
Affiliation(s)
- Tamara Ius
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy -
| | | | | | - Daniele Bagatto
- Neuroradiology Unit, Department of Diagnostic Imaging ASUIUD Udine, Italy
| | - Miriam Isola
- Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Claudio Battistella
- Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Simona Gaudino
- Institute of Radiology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | - Enrico Pegolo
- Institute of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Silvia Chiesa
- Institute of Radiotherapy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
| | | | | | | | - Miran Skrap
- Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Giovanni Sabatino
- Institute of Neurosurgery, Catholic University, Rome, Italy.,Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy
| |
Collapse
|
19
|
Comorbid Medical Conditions as Predictors of Overall Survival in Glioblastoma Patients. Sci Rep 2019; 9:20018. [PMID: 31882968 PMCID: PMC6934684 DOI: 10.1038/s41598-019-56574-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/09/2019] [Indexed: 02/07/2023] Open
Abstract
Glioblastoma (GBM) is an aggressive central nervous system tumor with a poor prognosis. This study was conducted to determine any comorbid medical conditions that are associated with survival in GBM. Data were collected from medical records of all patients who presented to VCU Medical Center with GBM between January 2005 and February 2015. Patients who underwent surgery/biopsy were considered for inclusion. Cox proportional hazards regression modeling was performed to assess the relationship between survival and sex, race, and comorbid medical conditions. 163 patients met inclusion criteria. Comorbidities associated with survival on individual-characteristic analysis included: history of asthma (Hazard Ratio [HR]: 2.63; 95% Confidence Interval [CI]: 1.24–5.58; p = 0.01), hypercholesterolemia (HR: 1.95; 95% CI: 1.09–3.50; p = 0.02), and incontinence (HR: 2.29; 95% CI: 0.95–5.57; p = 0.07). History of asthma (HR: 2.22; 95% CI: 1.02–4.83; p = 0.04) and hypercholesterolemia (HR: 1.99; 95% CI: 1.11–3.56; p = 0.02) were associated with shorter survival on multivariable analysis. Surgical patients with GBM who had a prior history of asthma or hypercholesterolemia had significantly higher relative risk for mortality on individual-characteristic and multivariable analyses.
Collapse
|
20
|
Saito T, Muragaki Y, Maruyama T, Komori T, Nitta M, Tsuzuki S, Fukui A, Kawamata T. Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy. Neurosurg Rev 2019; 43:1583-1593. [PMID: 31705405 DOI: 10.1007/s10143-019-01185-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/05/2019] [Accepted: 09/24/2019] [Indexed: 01/04/2023]
Abstract
The prognosis for glioblastoma (GBM) varies among patients. Ventricular opening during surgery has been reported as a prognostic factor for GBM patients, but the influence of ventricular opening itself on patient prognosis remains controversial. We presumed that the degree of ventricular opening would correlate with the degree of subventricular zone (SVZ) resection and with prognosis in GBM patients. This study therefore investigated whether the degree of ventricular opening correlates with prognosis in GBM patients treated with the standard protocol of chemo-radiotherapy. Participants comprised 111 patients with newly diagnosed GBM who underwent surgery and received postoperative radiotherapy and temozolomide-based chemotherapy from 2005 to 2018. We classified 111 patients into "No ventricular opening (NVO)", "Ventricular opening, small (VOS; distance < 23.2 mm)", and "Ventricular opening, wide (VOW; distance ≥ 23.2 mm)" groups. We evaluated the relationship between degree of ventricular opening and prognosis using survival analyses that included other clinicopathological factors. Log-rank testing revealed age, Karnofsky performance status (KPS), extent of resection, O6-methylguanine-DNA methyltransferase (MGMT) status, isocitrate dehydrogenase (IDH)1 mutation, and degree of ventricular opening correlated significantly with overall survival. Multivariate analysis identified the degree of ventricular opening (small vs. wide) as the most significant prognostic factor (hazard ratio = 3.674; p < 0.0001). We demonstrated that wide opening of the lateral ventricle (LV) contributes to longer survival compared with small opening among GBM patients. Our results indicate that wide opening of the LV may correlate with the removal of a larger proportion of tumor stem cells from the SVZ.
Collapse
Affiliation(s)
- Taiichi Saito
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Yoshihiro Muragaki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Maruyama
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Advanced Techno-Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takashi Komori
- Department of Laboratory Medicine and Pathology (Neuropathology), Tokyo Metropolitan Neurological Hospital, Tokyo, Japan
| | - Masayuki Nitta
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Shunsuke Tsuzuki
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Atsushi Fukui
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| |
Collapse
|
21
|
Wang Q, Zhang J, Li F, Xu X, Xu B. Diagnostic performance of clinical properties and conventional magnetic resonance imaging for determining the IDH1 mutation status in glioblastoma: a retrospective study. PeerJ 2019; 7:e7154. [PMID: 31275753 PMCID: PMC6590386 DOI: 10.7717/peerj.7154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/20/2019] [Indexed: 01/17/2023] Open
Abstract
Background Glioblastoma (GBM), the most malignant form of gliomas, is a relatively common primary brain tumor in adults. Preoperative identification of isocitrate dehydrogenase 1 (IDH1) mutations in GBM is of critical prognostic importance. The aim of the present study was to explore the feasibility and diagnostic performance of basic patient information combined with conventional magnetic resonance imaging (MRI) findings for determination of the IDH1 status (mutant vs wild type) in patients with GBM. Methods From January 1, 2016 to December 31, 2017, a consecutive series of 50 patients with GBM was retrospectively collected. The patients were divided into two group according to their IDH1 mutation status. Basic information and MRI features were analyzed for the establishment of a diagnostic prediction model using logistic regression. A receiver operating characteristic curve was used to evaluate the diagnostic performance. Results Patients with IDH1-mutant tumors were younger than those with IDH1-wild type tumors, and exhibited a larger tumor volume. The diagnostic predictive model established by combining age and the tumor size exhibited a sensitivity and specificity of 70% and 93%, respectively. The area under the curve was 0.88, which indicated high diagnostic performance. Conclusion Patient age and tumor volume can be used as indicators of IDH1 mutation status in patients with GBM, with high diagnostic performance for simple evaluations in clinical practice. The combined use of these two indicators can further enhance the diagnostic specificity.
Collapse
Affiliation(s)
- Qun Wang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing, China
| | - Jiashu Zhang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing, China
| | - Fangye Li
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing, China
| | - Xinghua Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing, China
| | - Bainan Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, Beijing, China
| |
Collapse
|
22
|
Awake surgery for glioblastoma can preserve independence level, but is dependent on age and the preoperative condition. J Neurooncol 2019; 144:155-163. [PMID: 31228139 DOI: 10.1007/s11060-019-03216-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/17/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Lately, awake surgery has been frequently adapted for glioblastoma (GBM). However, even with awake surgery, the expected long-term independence levels may not be achieved. We studied the characteristics of independence levels in GBM patients, and investigated the usefulness and parameter thresholds of awake surgery from the standpoint of functional outcomes. METHODS Totally, 60 GBM patients (awake group, n = 30; general anesthesia group, n = 30) who underwent tumor resection surgery were included. We collected preoperative and 1- and 3-month postoperative Karnofsky Performance Status (KPS) scores, and analyzed causes of low KPS scores from the aspect of function, brain region, and clinical factors. Then, we focused on the operative method, and investigated the usefulness of awake surgery. Finally, we explored the parameter standards of awake surgery in GBM considering independence levels. RESULTS Postoperative KPS were significantly lower than preoperative scores. Responsible lesions for low KPS scores were deep part of the left superior temporal gyrus and the right posterior temporal gyri that may be causes of aphasia and neuropsychological dysfunctions, respectively. Additionally, operative methods influenced on low independence level; long-term KPS scores in the awake group were significantly higher than those in the general anesthesia group, but they depended on age and preoperative KPS scores. Receiver operating characteristic curve analysis showed preoperative KPS = 90 and age = 62 years as the cutoff values for preservation of long-term KPS scores in awake group. CONCLUSION Awake surgery for GBM is useful for preserving long-term independence levels, but outcomes differ depending on age and preoperative KPS scores.
Collapse
|