Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma

Jin, Michael C.; Liu, Elisa K.; Shi, Siyu; Gibbs, Iris C.; Thomas, Reena; Recht, Lawrence D.; Soltys, Scott G.; Pollom, Erqi L.; Chang, Steven D.; Gephart, Melanie Hayden; Nagpal, Seema; Li, Gordon

doi:10.3389/fonc.2020.00337

Cited by 14 publications

(19 citation statements)

References 38 publications

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“…The extent of tumor resection is a well-established independent prognostic factor for improved OS in GBM [19]. It has also been described in GS [2,18,20,21,32]. In the current study, GTR did not lead to improved survival.…”

Section: Discussionsupporting

confidence: 52%

“…Adjuvant temozolomide therapy has become the standard of care in GBM management, leading to a statistically significant and clinically relevant survival benefit [12]. This has also been reported to some degree in GS, albeit mostly in studies with small patient numbers [6,20,33,34]. The largest registry study so far, however, confirmed the superiority of trimodality therapy also in GS [18].…”

Section: Discussionmentioning

confidence: 92%

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Chasing a rarity: a retrospective single-center evaluation of prognostic factors in primary gliosarcoma

et al. 2021

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Background and purpose Primary gliosarcoma (GS) is a rare variant of IDH-wildtype glioblastoma multiforme. We performed a single-center analysis to identify prognostic factors. Patients and methods We analyzed the records of 26 patients newly diagnosed with primary WHO grade IV GS. Factors of interest were clinical and treatment data, as well as molecular markers, time to recurrence, and time to death. Results Median follow-up was 9 months (range 5–21 months). Gross total resection did not lead to improved survival, most likely due to the relatively small sample size. Low symptom burden at the time of diagnosis was associated with longer PFS (P = 0.023) and OS (P = 0.018). Median OS in the entire cohort was 12 months. Neither MGMT promoter hypermethylation nor adjuvant temozolomide therapy influenced survival, consistent with some previous reports. Conclusion In this retrospective study, patients exhibiting low symptom burden at diagnosis showed improved survival. None of the other factors analyzed were associated with an altered outcome.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 92%

Chasing a rarity: a retrospective single-center evaluation of prognostic factors in primary gliosarcoma

et al. 2021

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“…The extent of resection was an independent prognostic factor of glioblastoma [10]. Tully's study suggests that reoperation in patients with recurrent glioblastoma may also prolong survival [11], and the results of this study were similar.…”

Section: Discussionsupporting

confidence: 69%

The extent of resection and adjuvant treatment are beneficial to the outcome of secondary glioblastoma

Hu¹,

Tu²,

Ji³

et al. 2021

Preprint

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Backgroud: to investigate secondary glioblastoma (sGBM) patients undergoing resection and evaluate the impact of treatment on survival of malignant progression (PMS) and the prognostic factors of secondary glioblastoma. Method: the prognostic factors of secondary glioblastoma were analyzed retrospectively including gender, age, the interval between first diagnosis and second, the extent of resection, adjuvant treatment, postoperative Karnofsky score (KPS), 06-methylguanine-DNA methytransferase (MGMT) status, IDH1 mutation status, and PMS in patients with sGBM. Result: Thirty-four patients with sGBM were included in this study. Sixteen patients were female and eighteen were male. Median PMS in females was longer than male patients with sGBM (17.38 (95%CI 10.63–24.12) vs 10.06(95%CI 5.32–14.79), p = 0.032). 22(64.7%) patients achieved gross total resection (GTR),12(35.3%) patients achieved subtotal resection (STR). Kaplan-Meier analysis showed that GTR significantly improved survival after malignant progression (PMS) compared with STR (17.18(95%CI 10.97–23.40) vs 7.17(95%CI 4.97–9.36), p = 0.004). Adjuvant treatment after resection was executed in 17 (50.0%) patients, radiotherapy in one (2.9%) patient, chemotherapy in seven (20.6%) patients, and radio-chemotherapy in nine (26.5%) patients. Median preoperative KPS was 80(range 30–100), and 85(range 30–100) after surgery. The difference in PMS probability was significant between patients having a good postoperative clinical status (KPS༞70)versus poor (KPS ≤ 70). Long term survival could be achieved in patients with a good clinical status (16.57(95%CI 10.54–22.60) vs 9.00(95%CI 3.66–14.34), p = 0.02). Patients with a greater interval after initial diagnosis had longer survival than those with intervals less than 26.5 months (18.62(95%CI 10.81–26.43) vs 9.22(95%CI 5.61–12.83), p = 0.025). Conclusion: GTR and any adjuvant treatment significantly improved PMS in patients with secondary glioblastoma. Gender, postoperative KPS, time interval since the first diagnosis are associated with prognosis.

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“…Although some retrospective studies have reached the opposite conclusions [9,11,24]. The resection range is a well-accepted independent prognostic factor for improved OS in GSM [4,5,17,26,27]. Cachia et al reported that patients of primary GSM undergoing GTR tended to have a greater OS (median 24.7 months) than those having subtotal resection (median 10.1 months) [25].…”

Section: Discussionmentioning

confidence: 99%

Prognostic Factors of Gliosarcoma in the Real World: A Retrospective Cohort Study

Zhou

et al. 2022

Preprint

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Introduction: Gliosarcoma is a histopathological variant of glioblastoma, which is characterized by a biphasic growth pattern consisting of glial and sarcoma components. Owing to its scarcity, data regarding the impact of available treatments on the clinical outcomes of gliosarcoma are inadequate. The purpose of this retrospective cohort study was to analyze the prognostic factors of gliosarcoma. Methods By screening the clinical database of neurosurgical cases at a single center, patients with gliosarcoma diagnosed histologically from 2015 to 2021 were identified. Clinical, pathological and molecular data were gathered founded on medical records and follow-up interviews. Prognostic factors were derived using Cox proportional hazards model with backward stepwise regression analysis. Results Forty-five GSM patients were included. Median overall survival was 20.6 months (95%CI 5.8 – 35.3), and median relapse free survival was 15.2 months (95%CI 6.1 – 24.3). In multivariable analysis, total resection (p = 0.029, HR = 0.198, 95%CI 0.046 – 0.849) indicated an improved prognosis. And low expression of Ki-67 (p = 0.067, HR = 2.813, 95%CI 0.930 – 8.506) would be likely to show statistical significance. However, there might be no statistically significant survival benefit from radiotherapy (n = 33, 75%, log-rank p = 0.92), adjuvant temozolomide (n = 33, 73.3%, log-rank p = 0.78) or concurrent temozolomide (n = 36, 80%, log-rank p = 0.79). Conclusion This retrospective study with a limited cohort size has demonstrated the treatment of gross total resection and low expression of Ki-67 are beneficial for patients with GSM, while radiotherapy or temozolomide is not.

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Evaluating Surgical Resection Extent and Adjuvant Therapy in the Management of Gliosarcoma

Cited by 14 publications

References 38 publications

Chasing a rarity: a retrospective single-center evaluation of prognostic factors in primary gliosarcoma

Chasing a rarity: a retrospective single-center evaluation of prognostic factors in primary gliosarcoma

The extent of resection and adjuvant treatment are beneficial to the outcome of secondary glioblastoma

Prognostic Factors of Gliosarcoma in the Real World: A Retrospective Cohort Study

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