Epidemiologic Features, Survival, and Prognostic Factors Among Patients With Different Histologic Variants of Glioblastoma: Analysis of a Nationwide Database

Abstract

Background: Glioblastoma (GBM) is the most common primary intracranial malignancy. Previous studies found incidence of GBM varies substantially by age, sex, race and ethnicity, and survival also varies by country, ethnicity, and treatment. Gliosarcoma (GSM) and giant cell glioblastoma (GC-GBM) are different histologic variants of GBM with distinct clinico-pathologic entities. We conducted a study to compare epidemiology, survival, and prognostic factors among the three.Methods: We identified GBM patients diagnosed between 2000 and 2016 using the Taiwan Cancer Registry and followed them using the death registry. Survival was compared among conventional GBM and two histologic variants. The potential confounding factors evaluated in this study included registered year, age, sex, and treatment modality (resection, radiotherapy, and chemotherapy).Results: We enrolled 3,895 patients, including 3,732 (95.8%) with conventional GBM, 102 (2.6%) with GSM, and 61 (1.6%) with GC-GBM. GC-GBM patients had younger mean age at diagnosis (49.5 years) than conventional GBM patients (58.7 years) and GSM patients (61.3 years) (p < 0.01). The three groups had similar sex distributions (p = 0.29). GC-GBM had a longer median survival [18.5, 95% confidence interval (CI): 15.8–25.3 months] than conventional GBM (12.5, 95%CI: 12.0–13.0 months) and GSM (12.8, 95%CI: 9.2–16.2 months), and the differences in overall survival did not attain statistical significance (p = 0.08, log-rank test). In univariate analysis, GC-GBM had better survival than conventional GBM, but the hazard ratio (0.91) did not reach statistical significance (95%CI: 0.69–1.20) in the multivariate analysis. Young ages (≤ 40 years), female sex, resection, radiotherapy, and chemotherapy were factors associated with better survival in overall GBMs. In subtype analyses, these factors remained statistically significant for conventional GBM, as well as radiotherapy for GSM.Conclusion: Our analysis found conventional GBM and its variants shared similar poor survival. Factors with age ≤ 40 years, female sex, resection, radiotherapy, and chemotherapy were associated with better prognosis in conventional GBM patients.

Comparison of healthcare utilization and life-sustaining interventions between patients with glioblastoma receiving palliative care or not: A population-based study

“…The mean referral time from diagnosis to palliative care was 489 ± 455 days, and survival from the referral date of palliative care was 100 ± 160 days. Those with palliative care had a significantly higher frequency of hospital admission (median [IQR]: 4 [3][4][5][6] vs 3 [2][3][4][5]; p < 0.0001) as well as a longer cumulative length of hospital stay (median [IQR]: 61 [38-95] vs 56 ; p < 0.0001). The frequencies of emergent department and outpatient department visits of those with palliative care were significantly higher than those without (emergent department, median [IQR]: 3 [1][2][3][4] vs 2 [1][2][3][4]; p = 0.01; outpatient department, median [IQR]: 32 vs 28 ; p < 0.001).…”

“…Those with palliative care had a significantly higher frequency of hospital admission (median [IQR]: 4 [3][4][5][6] vs 3 [2][3][4][5]; p < 0.0001) as well as a longer cumulative length of hospital stay (median [IQR]: 61 [38-95] vs 56 ; p < 0.0001). The frequencies of emergent department and outpatient department visits of those with palliative care were significantly higher than those without (emergent department, median [IQR]: 3 [1][2][3][4] vs 2 [1][2][3][4]; p = 0.01; outpatient department, median [IQR]: 32 vs 28 ; p < 0.001). However, compared with regular hospital admissions, the patients without palliative care had a significantly higher intensive care unit admission rate (median [IQR]: 1 [1][2][3] vs 0 [1-2]; p < 0.0001) and cumulative length of intensive care unit stay (median [IQR]: 5 days [1-18] vs 2 days [0-8]; p < 0.0001).…”

“…Glioblastoma is the most common central nervous system tumor in adults, which comprises the largest histologic group of brain tumors. 1,2 The clinical course of glioblastoma is typically rapid, with a dismal prognosis despite guideline-directed multimodality therapy. Although surgical resection of the brain tumor followed by concurrent chemo-radiotherapy is the standard of care, the clinical outcome remains poor.…”

Clinical trial design in the era of precision medicine

“…These trials recruited heavily pretreated patients with diverse tumor types, or patients for whom standard treatments had been exhausted. In addition, selected patients who participated in those trials had aggressive cancers, for which treatment options were limited [97][98][99]. In such patients, later lines of anticancer treatment are expected to yield low response rates [100,101], but targeted treatments evaluated in the aforementioned trials have been associated with significantly higher response rates than expected from standard treatment.…”

Freiburg Neuropathology Case Conference

“…astrocytomas IDH mutant grade 3 or 4 and glioblastomas IDH wildtype grade 4 were considered in this case) tend to spread along subcortical white matter and intrahemispheric as well as interhemispheric tracts, such as the corona radiata and the corpus callosum [ 9 ]. While high-grade IDH mutant astrocytomas mainly affect adults between 30 and 50 years of age [ 10 ], the peak incidence for glioblastomas is around 55 years [ 11 ]. As in this case, malignant gliomas are usually solitary, hypointense to isointense on T1, hyperintense T2/Fluid attenuated inversion recovery (FLAIR) and predominantly affect the white matter [ 12 ].…”