Impact of recurrence pattern in patients undergoing a second surgery for recurrent glioblastoma

Abstract

Background. The impact of different patterns of glioblastoma (GBM) recurrence has not yet been fully established in patients suitable for a second surgery. Through the present observational study carried out at Pisa University Hospital, we aimed to examine the impact of different patterns of GBM failure on patients' survival and second surgery outcomes. Methods. Overall survival was assessed according to clinical characteristics, including pattern of recurrence, in a prospective cohort of recurrent GBM patients. Survival curves were calculated using the Kaplan-Meier method and the log-rank test was applied to evaluate the differences between curves.Results. Contact with ventricles, a second surgery and meningeal spread had a statistically impact on patient survival after the diagnosis of GBM recurrence (P=0.032, P=0.019 and P<0.01, respectively).Patients with local recurrence had better survival than patients with non-local ones, 24.1 versus 18.2 months, respectively (P=0.015, HR=1.856 (1.130 -3.050). Considering the cohort as a whole, the second surgery conferred an advantage in recurrent survival respect to non-operated patients. However, this advantage was more evident in patients with local recurrence (P=0.002 with HR 0.212 (95% CI 0.081-0.552) and P=0.029 with HR=0.522 (95% CI 0.291-0.936), respectively).Conclusions. The local recurrence pattern could be a promising eld of interest for patients with recurrent GBM suitable for a second surgery.

Polyunsaturated Fatty Acid-Enriched Lipid Fingerprint of Glioblastoma Proliferative Regions Is Differentially Regulated According to Glioblastoma Molecular Subtype

“…Further, the TCGA-GBM database shows that low SOD2 (MnSOD) expression is associated with mutant IDH1 (R132H), proneural subtype, and more specifically with G-CIMP status. Interestingly, a recent observational prospective study describes how GBM patients with wild-type IDH1/2, with a Karnofsky Performance Score >80, treated with concomitant radio-chemotherapy and subsequent chemotherapy with TMZ—which presented non-local recurrence—have poorer overall survival than patients with local recurrence [ 77 ]. It might be of great interest to measure the expression of mesenchymal markers [ 78 ] in the subset of non-local recurrence patients, in order to describe a positive correlation.…”

New perspectives in liquid biopsy for glioma patients

“…For example, after diagnosis of disease recurrence, only patients with good Karnofsky Performance Status (KPS), tumor mass that can be largely removed and have recurred a considerable time after the first surgery, are candidates for surgery [9]. On the contrary, we have limited tumor tissue from patients with rapidly growing tumors (leading to rapid deterioration of the KPS), with a tumor resistant to radio-chemotherapy (progressing after a few months) or with a multicentric or multifocal recurrence pattern [10 ▪ ,11]. Therefore, biological characterization of recurrences using material from second surgeries suffers from significant selection bias.…”

Extracellular Vesicles Secreted by Glioma Stem Cells Are Involved in Radiation Resistance and Glioma Progression

“…Despite maximal safe surgical resection and a combination of radiotherapy and chemotherapy [ 1 , 2 ], tumour recurrence is almost always seen, probably due to tumour heterogeneity both at a phenotypic and a molecular level [ 3 ]. The prognosis remains poor, despite a gross total resection at the first and at the second surgery (recurrence); however, overall survival is better in patients who had second surgery with local recurrence compared to non-local recurrence [ 4 ], as well as in those with a combination of bevacizumab and fractionated stereotactic radiotherapy (FSRT) treatment [ 5 ].…”