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Journal of Neurosurgical Sciences 2020 Feb 04

DOI: 10.23736/S0390-5616.20.04850-X


language: English

Glioblastoma: from volumetric analysis to molecular predictors

Tamara IUS 1 , Fabrizio PIGNOTTI 2, Giuseppe M. DELLA PEPA 2, Daniele BAGATTO 3, Miriam ISOLA 4, Claudio BATTISTELLA 4, Simona GAUDINO 5, Enrico PEGOLO 6, Silvia CHIESA 7, Mauro ARCICASA 8, Giuseppe LA ROCCA 2, Alessandro OLIVI 2, Miran SKRAP 1, Giovanni SABATINO 2, 9

1 Neurosurgery Unit, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy; 2 Institute of Neurosurgery, Catholic University, Rome, Italy; 3 Neuroradiology Unit, Department of Diagnostic Imaging ASUIUD Udine, Italy; 4 Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy; 5 Institute of Radiology, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; 6 Institute of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy; 7 Institute of Radiotherapy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy; 8 Department of Radiotherapy, CRO, Aviano, Italy; 9 Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy


BACKGROUND: Despite decades of therapeutic and molecular refinements, the prognosis of patients with glioblastoma (GBM) still remains unfavorable. Integrative clinical studies allow a better understanding of the natural evolution of GBM. To assess independent predictors of overall survival (OS) and progression free survival (PFS) clinical, surgical, molecular and radiological variables were evaluated. A novel preoperative volumetric magnetic resonance imaging (MRI) index for tumor prognosis in GBM patients was investigated.
METHODS: A cohort of 195 cases of patients operated for newly GBM were analyzed. Extent of tumoral resection (EOR), tumor growth pattern, expressed by preoperative volumetric ΔT1-T2 MRI index, molecular markers such as O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase 1/2 (IDH1/2) mutation, were analyzed. Analysis of survival was done using Cox-proportional hazard models.
RESULTS: The 1-, 2- years estimated OS and PFS rate for the whole population were 61% and 27%, 38% and 17%, respectively.
A better survival rate, both in terms of survival and tumor progression, was observed in patient with higher EOR (p=0.000), younger age (p=0.000), MGMT methylation status (p=0.001) and lower preoperative ΔT1-T2 MRI index (p=0.004). Regarding the tumor growth pattern a cut-off value of 0.75 was found to discriminate patient with different prognosis. Patients with a preoperative ΔT1-T2 MRI index <0.75 had a 1-year estimated OS of 67%, otherwise patients with a preoperative ΔT1-T2 MRI index >0.75 hada 1-year estimated OS of 34%.
CONCLUSIONs: In this investigation longer survival is associated with younger age, EOR, promoter methylation of MGMT and preoperative tumor volumetric features expressed by ΔT1-T2 MRI index. The preoperative ΔT1-T2 MRI index could be a promising prognostic factor potentially useful in GBM management. Future investigations based on multiparametric MRI data and next generation sequences analysis, may better clarify this result.

KEY WORDS: Glioblastoma; Overall survival; Prognostic factors; Extent of resection (EOR); MRI tumoral growing pattern

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