Abstract
Because the study population with gliosarcoma (GSM) is limited, the understanding of this disease is insufficient. In this study, the authors aimed to determine the clinical characteristics and independent prognostic factors influencing the prognosis of GSM patients and to develop a nomogram to predict the prognosis of GSM patients after craniotomy. A total of 498 patients diagnosed with primary GSM between 2004 and 2015 were extracted from the 18 Registries Research Data of the Surveillance, Epidemiology, and End Results (SEER) database. The median disease-specific survival (DSS) was 12.0 months, and the postoperative 0.5-, 1-, and 3-year DSS rates were 71.4%, 46.4% and 9.8%, respectively. We applied both the Cox proportional hazards model and the decision tree model to determine the prognostic factors of primary GSM. The Cox proportional hazards model demonstrated that age at presentation, tumour size, metastasis state and adjuvant chemotherapy (CT) were independent prognostic factors for DSS. The decision tree model suggested that age <71 years and adjuvant CT were associated with a better prognosis for GSM patients. The nomogram generated via the Cox proportional hazards model was developed by applying the rms package in R version 3.5.0. The C-index of internal validation for DSS prediction was 0.67 (95% confidence interval (CI), 0.63 to 0.70). The calibration curve at one year suggested that there was good consistency between the predicted DSS and the actual DSS probability. This study was the first to develop a disease-specific nomogram for predicting the prognosis of primary GSM patients after craniotomy, which can help clinicians immediately and accurately predict patient prognosis and conduct further treatment.
Highlights
Gliosarcoma (GSM) is a rare malignant brain tumour composed of both glial and sarcomatous elements, the incidence of which is between 1% and 8% of all malignant gliomas[1,2,3]
The results demonstrated that age at presentation, site of the tumour, tumour size, metastasis state, adjuvant chemotherapy (CT) and adjuvant radiotherapy (RT) were significantly associated with GSM patient survival
Our study suggested that patients with tumour metastasis had a worse prognosis, which was verified in another study[21]
Summary
Gliosarcoma (GSM) is a rare malignant brain tumour composed of both glial and sarcomatous elements, the incidence of which is between 1% and 8% of all malignant gliomas[1,2,3]. GSM was first described by Stroebe in 1895 as a variant of glioblastoma (GBM) and gained wide acceptance after Feigin et al and Rubinstein et al published their papers presenting several patients with this malignant tumour in detail[4,5,6]. Due to the low incidence of GSM, there are few studies describing the patient characteristics, treatment regimen and prognosis of GSM. The nomogram has been widely used to predict the prognosis of patients with malignant tumours[13,14,15,16]. To our knowledge, no published literature has proposed a nomogram to predict the prognosis of primary GSM patients after craniotomy. Our study intended to develop a nomogram that can be applied to individually assess the survival time of patients with primary GSM after craniotomy and to discuss different factors influencing the prognosis of GSM patients
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