Differential effect of vascularity between long‐ and short‐term survivors with IDH1/2 wild‐type glioblastoma

Abstract

Introduction IDH1/2 wt glioblastoma (GB) represents the most lethal tumour of the central nervous system. Tumour vascularity is associated with overall survival (OS), and the clinical relevance of vascular markers, such as rCBV, has already been validated. Nevertheless, molecular and clinical factors may have different influences on the beneficial effect of a favourable vascular signature. Purpose To evaluate the association between the rCBV and OS of IDH1/2 wt GB patients for long‐term survivors (LTSs) and short‐term survivors (STSs). Given that initial high rCBV may affect the patient's OS in follow‐up stages, we will assess whether a moderate vascularity is beneficial for OS in both groups of patients. Materials and methods Ninety‐nine IDH1/2 wt GB patients were divided into LTSs (OS ≥ 400 days) and STSs (OS < 400 days). Mann‐Whitney and Fisher, uni‐ and multiparametric Cox, Aalen’s additive regression and Kaplan‐Meier tests were carried out. Tumour vascularity was represented by the mean rCBV of the high angiogenic tumour (HAT) habitat computed through the haemodynamic tissue signature methodology (available on the ONCOhabitats platform). Results For LTSs, we found a significant association between a moderate value of rCBVmean and higher OS (uni‐ and multiparametric Cox and Aalen’s regression) (p = 0.0140, HR = 1.19; p = 0.0085, HR = 1.22) and significant stratification capability (p = 0.0343). For the STS group, no association between rCBVmean and survival was observed. Moreover, no significant differences (p > 0.05) in gender, age, resection status, chemoradiation, or MGMT methylation were observed between LTSs and STSs. Conclusion We have found different prognostic and stratification effects of the vascular marker for the LTS and STS groups. We propose the use of rCBVmean at HAT as a vascular marker clinically relevant for LTSs with IDH1/2 wt GB and maybe as a potential target for randomized clinical trials focused on this group of patients.

Ketogenic Metabolic Therapy, Without Chemo or Radiation, for the Long-Term Management of IDH1-Mutant Glioblastoma: An 80-Month Follow-Up Case Report

“…Glioblastoma (GBM) has among the highest mortality rates for primary brain tumors and remains poorly manageable. Despite the hype surrounding recent therapies (1)(2)(3)(4)(5), median life expectancy following diagnosis remains poor for most GBM patients (6)(7)(8)(9). Survival is slightly better, however, for younger GBM patients compared to older GBM patients and for patients with GBM tumors that express IDH1 mutations (10)(11)(12)(13)(14).…”

The prognostic relevance of a gene expression signature in MRI-defined highly vascularized glioblastoma

“…Firstly, the sample size of patients with MRI-defined vascularity was limited. Secondly, the use of an equal weighting system for all genes in the score system potentially overlooked vital contributions from individual genes [ 49 ]. Addressing these limitations through further validation studies could refine the accuracy and applicability of the findings, informing future clinical approaches.…”

Local detection of microvessels in IDH-wildtype glioblastoma using relative cerebral blood volume: an imaging marker useful for astrocytoma grade 4 classification

“…The results derived from this work suggest the potential of imaging vascular markers calculated with the ONCOhabitats platform for helping in unmet challenges in high-grade glioma management, including glioma classification and prediction of IDH mutation status, with a non-invasive method and from the initial stage of diagnosis. We consider that the rCBV is a clinically relevant option for decision making in glioblastoma [12,29,30], since it could be a complementary tool to histopathology for analyzing intratumor vascular heterogeneity at both temporal and spatial levels in a non-invasive way [23]. This marker could be especially relevant for inoperable tumors, for which an exhaustive histopathological analysis cannot be performed.…”