Abstract
BackgroundThe extent of resection of non-contrast enhancing tumors (EOR-NCEs) has been shown to be associated with prognosis in patients with newly diagnosed glioblastoma (nGBM). This study aimed to develop and independently validate a nomogram integrated with EOR-NCE to assess individual prognosis.MethodsData for this nomogram were based on 301 patients hospitalized for nGBM from October 2011 to April 2019 at the Beijing Tiantan Hospital, Capital Medical University. These patients were randomly divided into derivation (n=181) and validation (n=120) cohorts at a ratio of 6:4. To evaluate predictive accuracy, discriminative ability, and clinical net benefit, concordance index (C-index), receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA) were calculated for the extent of resection of contrast enhancing tumor (EOR-CE) and EOR-NCE nomograms. Comparison between these two models was performed as well.ResultsThe Cox proportional hazards model was used to establish nomograms for this study. Older age at diagnosis, Karnofsky performance status (KPS)<70, unmethylated O6-methylguanine-DNA methyltransferase (MGMT) status, wild-type isocitrate dehydrogenase enzyme (IDH), and lower EOR-CE and EOR-NCE were independent factors associated with shorter survival. The EOR-NCE nomogram had a higher C-index than the EOR-CE nomogram. Its calibration curve for the probability of survival exhibited good agreement between the identical and actual probabilities. The EOR-NCE nomogram showed superior net benefits and improved performance over the EOR-CE nomogram with respect to DCA and ROC for survival probability. These results were also confirmed in the validation cohort.ConclusionsAn EOR-NCE nomogram assessing individualized survival probabilities (12-, 18-, and 24-month) for patients with nGBM could be useful to provide patients and their relatives with health care consultations on optimizing therapeutic approaches and prognosis.
Highlights
Glioblastoma (GBM) is the most fatal and malignant of primary brain tumors in adults [1,2,3]
For the EOR-non-contrast enhancing tumor (NCE) nomogram, multivariate Cox regression analyses indicated that older age (HR=1.019, 95% confidence interval [CI]: 1.003–1.035, P=0.020), Karnofsky performance status (KPS)≥70 (HR=0.455, 95% CI: 0.280–0.739, P=0.001), methylated methylguanine-DNA methyltransferase (MGMT) (HR=0.539, 95% CI: 0.372–0.780, P=0.001), isocitrate dehydrogenase enzyme (IDH) mutant (HR=0.311, 95% CI: 0.160–0.606, P
For the extent of resection of CE tumors (EOR-CE) nomogram, multivariate Cox regression analyses showed that older age (HR=1.016, 95% CI: 1.000– 1.032, P=0.047), KPS≥70 (HR=0.476, 95% CI: 0.294–0.769, P=0.002), methylated MGMT (HR=0.637, 95% CI: 0.445– 0.912, P=0.013), IDH mutant (HR=0.301, 95% CI: 0.155–0.582, P
Summary
Glioblastoma (GBM) is the most fatal and malignant of primary brain tumors in adults [1,2,3]. Advanced treatments have been applied in patients with newly diagnosed GBM (nGBM), satisfactory outcomes are rarely achieved. The high heterogeneity of GBM leads to a variable prognosis for these patients. Several clinical, imaging and biomarker studies have been employed to identify variable outcomes in patients with GBM. Karnofsky performance status (KPS), extent of surgical resection, O6-methylguanine-DNA methyltransferase (MGMT) methylation status and isocitrate dehydrogenase enzyme (IDH) mutation are the most uniformly documented prognostic factors in previous studies [4, 5]. The extent of resection of non-contrast enhancing tumors (EOR-NCEs) has been shown to be associated with prognosis in patients with newly diagnosed glioblastoma (nGBM). This study aimed to develop and independently validate a nomogram integrated with EOR-NCE to assess individual prognosis
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