The clinical characteristics and prognostic factors of multiple lesions in glioblastomas

Tunthanathip, Thara; Sangkhathat, Surasak; Tanvejsilp, Pimwara; Kanjanapradit, Kanet

doi:10.1016/j.clineuro.2020.105891

Cited by 11 publications

(15 citation statements)

References 24 publications

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“…mGBM represents a special sub-group of glioblastomas, accounting for around 10 to 20% of all cases and associated with significantly reduced overall survival [14,18,19,23,24] as was also shown for our cohort. Several, mostly retrospective, studies have investigated the prognostic effects comparing craniotomy (including gross total resection, GTR, and sub-total resection, STR) to biopsy only for patients with first diagnosis of multifocal glioma.…”

Section: Discussionsupporting

confidence: 84%

“…Especially clinical management of multifocal GBM (mGBM) is often difficult due to reduced rates of gross total resection (or craniotomy in general) causing significantly shorter overall survival (OS) [ 15 ]. While clinical factors and molecular characteristics have been investigated for both unifocal glioblastoma (uGBM) and mGBM [ 16 , 17 , 18 , 19 ], data about the prognostic impact of radiological parameters for multifocal GBM are scarce [ 20 , 21 ]. Hence, this retrospective study investigated whether additional MRI characteristics (initial tumor volume, necrosis volume, residual volume) of mGBM provide prognostic information and how these data statistically implement into overall prognosis when established clinical and molecular factors are considered.…”

Section: Introductionmentioning

confidence: 99%

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On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI

et al. 2021

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Primary glioblastoma (GBM), IDH-wildtype, especially with multifocal appearance/growth (mGBM), is associated with very poor prognosis. Several clinical parameters have been identified to provide prognostic value in both unifocal GBM (uGBM) and mGBM, but information about the influence of radiological parameters on survival for mGBM cohorts is scarce. This study evaluated the prognostic value of several volumetric parameters derived from magnetic resonance imaging (MRI). Data from the Department of Neurosurgery, Leipzig University Hospital, were retrospectively analyzed. Patients treated between 2014 and 2019, aged older than 18 years and with adequate peri-operative MRI were included. Volumetric assessment was performed manually. One hundred and eighty-three patients were included. Survival of patients with mGBM was significantly shorter (p < 0.0001). Univariate analysis revealed extent of resection, adjuvant therapy regimen, residual tumor volume, tumor necrosis volume and ratio of tumor necrosis to initial volume as statistically significant for overall survival. In multivariate Cox regression, however, only EOR (for uGBM and the entire cohort) and adjuvant therapy were independently significant for survival. Decreased ratio of tumor necrosis to initial tumor volume and extent of resection were associated with prolonged survival in mGBM but failed to achieve statistical significance in multivariate analysis.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI

et al. 2021

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“… 6 The findings may be an effect from competing events of patients with multiple lesions associated with poor prognosis. 32 33 …”

Section: Discussionmentioning

confidence: 99%

Risk Factors Associated with Malignant Transformation of Astrocytoma: Competing Risk Regression Analysis

2022

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Background Malignant transformation (MT) of low-grade astrocytoma (LGA) triggers a poor prognosis in benign tumors. Currently, factors associated with MT of LGA have been inconclusive. The present study aims to explore the risk factors predicting LGA progressively differentiated to malignant astrocytoma. Methods The study design was a retrospective cohort study of medical record reviews of patients with LGA. Using the Fire and Gray method, the competing risk regression analysis was performed to identify factors associated with MT, using both univariate and multivariable analyses. Hence, the survival curves of the cumulative incidence of MT of each covariate were constructed following the final model. Results Ninety patients with LGA were included in the analysis, and MT was observed in 14.4% of cases in the present study. For MT, 53.8% of patients with MT transformed to glioblastoma, while 46.2% differentiated to anaplastic astrocytoma. Factors associated with MT included supratentorial tumor (subdistribution hazard ratio [SHR] 4.54, 95% confidence interval [CI] 1.08–19.10), midline shift > 1 cm (SHR 8.25, 95% CI 2.18–31.21), and nontotal resection as follows: subtotal resection (SHR 5.35, 95% CI 1.07–26.82), partial resection (SHR 10.90, 95% CI 3.13–37.90), and biopsy (SHR 11.10, 95% CI 2.88–42.52). Conclusion MT in patients with LGA significantly changed the natural history of the disease to an unfavorable prognosis. Analysis of patients' clinical characteristics from the present study identified supratentorial LGA, a midline shift more than 1 cm, and extent of resection as risk factors associated with MT. The more extent of resection would significantly help to decrease tumor burden and MT. In addition, future molecular research efforts are warranted to explain the pathogenesis of MT.

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“…Multicentric GBM is one of the subgroups of multiple GBMs in which the centers of the tumors are clearly disconnected from each other, such as in different lobes or bilateral tumors, with no apparent route of dissemination. [25][26][27] Multi-stage operations need to be performed for total tumor resection in this subgroup.…”

Section: Discussionmentioning

confidence: 99%

Effect of the Extent of Resection on Survival Outcome in Glioblastoma: Propensity Score Approach

Tunthanathip

Madteng

2020

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

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Objective To evaluate the effectiveness of the extent of resection (EOR) on survival outcome using propensity score-based approaches. Materials and Methods A retrospective cohort study was performed in patients with newly diagnosed glioblastoma. Propensity score matching (PSM) and propensity score regression adjustment were used in the matched and unmatched dataset, respectively. Therefore, the Kaplan-Meier survival curve and Cox's regression analyses were performed to determine the effect of the EOR on survival outcomes. Results One hundred and sixty-eight patients were included for analyzes. The total tumor resection in the unmatched dataset was 22.6% of all cases. Using PSM, incomplete tumor resection had an unfavorable survival outcome when compared with total tumor resection (hazard ratio (HR) 2.92, 95% confidence interval [CI] 1.72–4.94). Additionally, biopsy and partial tumor resection were significantly associated with poor prognosis when compared with total tumor resection using propensity score regression adjustment (HR of biopsy 1.89, 95%CI 1.13–3.16 and HR of partial resection 1.89, 95%CI 1.28–2.80). Conclusions Patients with total tumor resection tend to have a more favorable prognosis than patients with partial tumor resection. The propensity score-based analysis is an alternative approach to evaluate the effect of an intervention that has limitations to perform a randomized controlled trial.

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The clinical characteristics and prognostic factors of multiple lesions in glioblastomas

Cited by 11 publications

References 24 publications

On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI

On the Prognosis of Multifocal Glioblastoma: An Evaluation Incorporating Volumetric MRI

Risk Factors Associated with Malignant Transformation of Astrocytoma: Competing Risk Regression Analysis

Effect of the Extent of Resection on Survival Outcome in Glioblastoma: Propensity Score Approach

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