Temporal muscle thickness as an independent prognostic imaging marker in newly diagnosed glioblastoma patients: A validation study

Abstract

Background Previous studies have recognized temporal muscle thickness (TMT) as a prognostic marker in glioblastoma, but clinical implementation is hampered due to studies’ heterogeneity and lack of established cutoff values. The aim of this study was to assess the validity of recent proposed sex-specific TMT cutoff values in a real-world population of genotyped primary glioblastoma patients. Methods We measured TMT in preoperative MR images of 328 patients. Sex-specific TMT cutoff values were used to divide patients in ‘at risk of sarcopenia’ or ‘normal muscle status’. Kaplan-Meier analyses and stepwise multivariate Cox-Regression analyses were used to assess the association with overall survival (OS) and progression free survival (PFS). The association with occurrence of complications and discontinuation of glioblastoma treatment was investigated using odds ratios (OR). Results Patients at risk of sarcopenia had a significantly higher risk of progression and death than patients with normal muscle status, which remained significant in the multivariate analyses (OS HR=1.437; 95%CI: 1.046-1.973; p=0.025 and PFS HR=1.453; 95%CI: 1.037-2.036; p=0.030). Patients at risk of sarcopenia also had a significantly higher risk of early discontinuation of treatment (OR=2.45; 95%CI: 1.011-5.952; p=0.042) and a significantly lower chance of receiving second line treatment (OR=0.23; 95%CI: 0.09-0.60; p=0.001). There was no association with the occurrence of complications. Conclusions Our study confirms external validity of the use of proposed sex-specific TMT cutoff values as an independent prognostic marker in newly diagnosed glioblastoma patients. This simple, noninvasive marker could improve patient counselling and aid in treatment decision processes or trial stratification.

Correlation of reduced temporal muscle thickness and systemic muscle loss in newly diagnosed glioblastoma patients

“…Whatever the cause is, glioblastoma patients at risk of sarcopenia have a higher risk of a short TTP after finalizing first line multimodality treatment and death than patients with normal muscle status, and also a higher risk of early discontinuation of treatment [ 9 ]. Glioblastoma patients might benefit from targeting muscle loss early in the diagnostic or treatment process.…”

“…Patients with adequate preoperative brain Magnetic Resonance (MR) imaging as well as preoperative diagnostic abdominal CT scans were selected for this study. Patient characteristics and clinical data were collected from medical records as previously described [ 9 ].…”

“…TMT measurements were performed on axial isotropic (1 × 1 × 1 mm) contrast-enhanced T1-weighted MR images, which were routinely performed for neurosurgery navigation on the same day or one day before surgery, as previously described [ 9 ]. In short: the MR plane was oriented parallel to the anterior commissure-posterior commissure line.…”

“…The past 5 years, reduced temporal muscle thickness (TMT) has been studied as a potential prognostic imaging marker and objective tool to assess patients’ frailty in both recurrent as well as de novo glioblastoma patients. Some confirmed its prognostic value in newly diagnosed glioblastoma [ 4 – 9 ], whereas others rejected it [ 10 – 12 ]. In addition, some reported only a prognostic role in recurrent, but not newly diagnosed, glioblastoma patients [ 11 , 13 ].…”

High Expression of Kynurenine Pathway Markers in Glioblastoma: Prognostic Relevance

“…From an existing genotyped glioma database covering routine clinical diagnostics, data and tissue samples from 135 glioblastoma patients diagnosed or treated in Maastricht University Medical Center+ (MUMC+, the Netherlands) between 2006-2014 were available [17]. For our study, only patients with newly diagnosed glioblastoma (WHO grade 4), isocitrate dehydrogenase gene 1 or 2 (IDH1/2) wildtype and MGMT hypermethylated or unmethylated were included.…”