Survival in a consecutive series of 467 glioblastoma patients: Association with prognostic factors and treatment at recurrence at two independent institutions

Blakstad, Hanne; Brekke, Jorunn; Rahman, Mohummad Aminur; Arnesen, Victoria Smith; Miletić, Hrvoje; Brandal, Petter; Lie, Stein Atle; Chekenya, Martha; Goplen, Dorota

doi:10.1371/journal.pone.0281166

Cited by 10 publications

(12 citation statements)

References 27 publications

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“…2,3 A latest clinical study analyzed the prognosis of 467 recurrent GBM patients from two institutions and revealed that tumor location is an independent predictive factor. 4 Second, we agree that there are numerous variables interacting with each other and all these variables finally lead to a health event in a complicated way. For example, GBM patients are generally older than low-grade glioma (LGG) patients and meanwhile age is also associated with tumor-related molecular alterations like isocitrate dehydrogenase 1 (IDH1) mutation.…”

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confidence: 78%

Reply to: Comments on “New insights into glioma frequency maps: From genetic and transcriptomic correlate to survival prediction”

Bao

Ren

Peng

et al. 2023

Intl Journal of Cancer

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We also admit that the performance of all kinds of survival prediction models remains unsatisfactory, but we should still spare no efforts to screen more predictive risk factors and develop novel methods to make individualized therapy a reality.First, the authors suggest that tumor anatomical localization is not associated with overall survival. This might be true in some types of cancer. However, in glioblastoma multiforme (GBM), there is much evidence supporting that tumor invasion status could determine the distinct prognosis and provide clinical indexes in radiotherapy and chemotherapy decision-making for individual patients. 2,3 A latest clinical study analyzed the prognosis of 467 recurrent GBM patients from two institutions and revealed that tumor location is an independent predictive factor. 4 Second, we agree that there are numerous variables interacting with each other and all these variables finally lead to a health event in a complicated way. For example, GBM patients are generally older than low-grade glioma (LGG) patients and meanwhile age is also associated with tumor-related molecular alterations like isocitrate dehydrogenase 1 (IDH1) mutation. 5 Our results also indicate that tumor location, to some extent, reflects the activity of neurotransmitter-mediated intercellular communication. We believe that a deeper understanding of how a single factor has synergistic or antagonistic effects on the others can help us uncover the mysteries of tumorigenesis. In addition, current methods, such as least absolute shrinkage and selection operator (LASSO) and general linear model (GLM), can eliminate the interactive effects and identify the most contributing variables in survival prediction. 6 Third, postoperative survival time is the most prominent concern among GBM patients and family members. Considering that the 1-year survival rate is an important indicator in clinical practice and the median survival of GBM is around 12 to 14 months, 7 patients in our study were labeled with "poor survival" (<12 months) or "good survival" (≥12 months). This is a simple and quick way to evaluate a patient's prognosis. Of cause, unsupervised learning approaches can also achieve this aim and we would like to attempt more methods and compare their performance in the future.Forth, the road to reaching personalized medicine is still long and winding. Many challenges must be overcome and how to improve the accuracy and precision of the prediction model is a critical issue. In most cases, a combination of molecular signatures, treatment strategy and other multiomics data could improve the predictive ability. 8 We point out that tumor location could be included as a predictor in these models, which may contribute to a more accurate result. As to precision, more studies based on largescale populations are needed. In fact, no single approach is universally effective. In other words, we cannot construct a model which is 100% accurate or precise. But through our efforts, the prospects of individualized prediction are still promising...

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confidence: 78%

Reply to: Comments on “New insights into glioma frequency maps: From genetic and transcriptomic correlate to survival prediction”

Bao

Ren

Peng

et al. 2023

Intl Journal of Cancer

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“…In this study, we further discovered that the underlying mechanisms contributing to the clinical functional impairments caused by GBM and astrocytoma differ from each other. Previously, certain traditional anatomical structures such as the brainstem, corpus callosum, and thalamus have been considered as prognostic factors for poor outcomes ( 50 ). However, in this study, we went beyond anatomical boundaries and employed the VLSM method to identify ROIs that can also serve as prognostic indicators.…”

Section: Discussionmentioning

confidence: 99%

The involvement of brain regions associated with lower KPS and shorter survival time predicts a poor prognosis in glioma

Bao,

Wang,

Sun

et al. 2023

Front. Neurol.

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BackgroundIsocitrate dehydrogenase-wildtype glioblastoma (IDH-wildtype GBM) and IDH-mutant astrocytoma have distinct biological behaviors and clinical outcomes. The location of brain tumors is closely associated not only with clinical symptoms and prognosis but also with key molecular alterations such as IDH. Therefore, we hypothesize that the key brain regions influencing the prognosis of glioblastoma and astrocytoma are likely to differ. This study aims to (1) identify specific regions that are associated with the Karnofsky Performance Scale (KPS) or overall survival (OS) in IDH-wildtype GBM and IDH-mutant astrocytoma and (2) test whether the involvement of these regions could act as a prognostic indicator.MethodsA total of 111 patients with IDH-wildtype GBM and 78 patients with IDH-mutant astrocytoma from the Cancer Imaging Archive database were included in the study. Voxel-based lesion-symptom mapping (VLSM) was used to identify key brain areas for lower KPS and shorter OS. Next, we analyzed the structural and cognitive dysfunction associated with these regions. The survival analysis was carried out using Kaplan–Meier survival curves. Another 72 GBM patients and 48 astrocytoma patients from Harbin Medical University Cancer Hospital were used as a validation cohort.ResultsTumors located in the insular cortex, parahippocampal gyrus, and middle and superior temporal gyrus of the left hemisphere tended to lead to lower KPS and shorter OS in IDH-wildtype GBM. The regions that were significantly correlated with lower KPS in IDH-mutant astrocytoma included the subcallosal cortex and cingulate gyrus. These regions were associated with diverse structural and cognitive impairments. The involvement of these regions was an independent predictor for shorter survival in both GBM and astrocytoma.ConclusionThis study identified the specific regions that were significantly associated with OS or KPS in glioma. The results may help neurosurgeons evaluate patient survival before surgery and understand the pathogenic mechanisms of glioma in depth.

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“…Glioma type and entity (the term used in the WHO 2016 classification now changed to “type”) are associated with patient survival ( Supplementary Table S1 in the Electronic Supplementary Material [ESM]) ( 5 , 10 – 27 ). Survival is poorest in patients with glioblastoma, where median overall survival (OS) was between 9 ( 11 ) and 26 ( 14 ) months.…”

Section: Disease Classification Grading and Associated Survivalmentioning

confidence: 99%

“…In glioblastoma, progression predicts shorter OS as shown in recent analyses from the ETERNITY, where the median OS in patients surviving ≥5 years from glioblastoma diagnosis was 9.9 years overall but was not reached in patients without recurrence relative to 8.9 years in patients with ≥1 recurrence ( 16 ). Unsurprisingly, survival in glioblastoma is associated with treatment, including surgery and chemotherapy; in Norway, median OS was reported as 6.8 months in those receiving only biopsy and 17.2 months in those with gross total resection ( 10 ). Similar data were available for the UK, where biopsy only was associated with a median OS of 8.0 months relative to 14.9 months in those with debulking surgery ( 11 ), and for Denmark, where biopsy only was associated with a median OS of 4.7 months, compared with 15.6 months in those with gross total resection ( 28 ).…”

Section: Disease Classification Grading and Associated Survivalmentioning

confidence: 99%

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Pöhlmann,

Weller,

Marcellusi

et al. 2024

Front. Oncol.

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Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.

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Survival in a consecutive series of 467 glioblastoma patients: Association with prognostic factors and treatment at recurrence at two independent institutions

Cited by 10 publications

References 27 publications

Reply to: Comments on “New insights into glioma frequency maps: From genetic and transcriptomic correlate to survival prediction”

Reply to: Comments on “New insights into glioma frequency maps: From genetic and transcriptomic correlate to survival prediction”

The involvement of brain regions associated with lower KPS and shorter survival time predicts a poor prognosis in glioma

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

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