Abstract
Glioblastoma (GBM) is the most aggressive primary brain tumor and can have cystic components, identifiable through magnetic resonance imaging (MRI). Previous studies suggest that cysts occur in 7–23% of GBMs and report mixed results regarding their prognostic impact. Using our retrospective cohort of 493 patients with first-diagnosis GBM, we carried out an exploratory analysis on this potential link between cystic GBM and survival. Using pretreatment MRIs, we manually identified 88 patients with GBM that had a significant cystic component at presentation and 405 patients that did not. Patients with cystic GBM had significantly longer overall survival and were significantly younger at presentation. Within patients who received the current standard of care (SOC) (N = 184, 40 cystic), we did not observe a survival benefit of cystic GBM. Unexpectedly, we did not observe a significant survival benefit between this SOC cystic cohort and patients with cystic GBM diagnosed before the standard was established (N = 40 with SOC, N = 19 without SOC); this significant SOC benefit was clearly observed in patients with noncystic GBM (N = 144 with SOC, N = 111 without SOC). When stratified by sex, the survival benefit of cystic GBM was only preserved in male patients (N = 303, 47 cystic). We report differences in the absolute and relative sizes of imaging abnormalities on MRI and the prognostic implication of cysts based on sex. We discuss hypotheses for these differences, including the possibility that the presence of a cyst could indicate a less aggressive tumor.
Highlights
Glioblastoma (GBM) is the most common and aggressive primary brain tumor with a median survival of only 15–16 months and a 5-year survival rate of 5–10% with the current standard-of-care treatment [1,2,3]
Cystic fluid is typically isointense with cerebrospinal fluid (CSF) on T2 and FLAIR magnetic resonance imaging (MRI) and has a notably smooth texture. While these cysts are more common in lower grade gliomas and non-glioma tumors with good prognosis, between 7 and 23% of GBM tumors can present with dominant cystic components (Figure 1B) [4, 5]
When comparing the relative sizes of the T1Gd and T2/FLAIR volumes (T1Gd/T2FLAIR), we found that cystic GBM have a smaller relative T2/FLAIR component compared to noncystic GBM (p = 0.0003) (Figure 3D)
Summary
Glioblastoma (GBM) is the most common and aggressive primary brain tumor with a median survival of only 15–16 months and a 5-year survival rate of 5–10% with the current standard-of-care treatment [1,2,3]. Cystic fluid is typically isointense with cerebrospinal fluid (CSF) on T2 and FLAIR MRI and has a notably smooth texture While these cysts are more common in lower grade gliomas (e.g., juvenile pilocytic astrocytoma, ganglioglioma) and non-glioma tumors with good prognosis (e.g., hemangioblastoma), between 7 and 23% of GBM tumors can present with dominant cystic components (rather than necrosis) (Figure 1B) [4, 5]. Given the higher prevalence of cysts in lower grade tumors, there have been a number of studies looking for a mechanism behind the improved prognosis of patients with cystic GBM, including notable molecular compounds present in cystic GBM fluid, histopathological differences between cystic and noncystic GBM and prevalence of IDH1 mutants in cystic GBM [11, 12]. We further explore these effects within patient sex and with respect to standard-of-care treatment
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