Prognostic factors influencing clinical outcomes of malignant glioblastoma multiforme: clinical, immunophenotypic, and fluorescence in situ hybridization findings for 1p19q in 816 chinese cases.

Jun-Jie Qin,Gui-Lin Li,Li Xu,Jiang Du,Zhi-Dong Li,Wu Han,Jian Xie,Chun Zeng,Zhao-Xia Liu,Jun-Mei Wang

doi:10.7314/apjcp.2015.16.3.971

Abstract

Malignant glioblastoma multiforme (GBM) is the most malignant brain tumor and despite recent advances in diagnostics and treatment prognosis remains poor. In this retrospective study, we assessed the clinical and radiological parameters, as well as fluorescence in situ hybridization (FISH) of 1p19q deletion, in a series of cases. A total of 816 patients with GBM who received surgery and radiation between January 2010 and May 2014 were included in this study. Kaplan-Meier survival analysis and Cox regression analysis were used to find the factors independently influencing patient progression free survival (PFS) and overall survival (OS). Age at diagnosis, preoperative Karnofsky Performance Scale (KPS) score, KPS score change at 2 weeks after operation, neurological deficit symptoms, tumor resection extent, maximal tumor diameter, involvement of eloquent cortex or deep structure, involvement of brain lobe, Ki-67 and MMP9 expression level and adjuvant chemotherapy were statistically significant factors (p<0.05) for both PFS and OS in the univariate analysis. Cox proportional hazards modeling revealed that age ≤50 years, preoperative KPS score ≥80, KPS score change after operation ≥0, involvement of single frontal lobe, deep structure involvement, low Ki-67 and MMP9 expression and adjuvant chemotherapy were independent favorable factors (p<0.05) for patient clinical outcomes.

Highlights

Malignant glioblastoma multiform (GBM, World Health Organization (WHO) grade IV) are the most malignant and prevalent intracranial tumor providing for well over one half of all gliomas (Hoffman et al, 2006; Schneider et al, 2010)
fluorescence in situ hybridization (FISH) of 1p19q were performed in 80 cases. (iii) Demographic data of these patients, Preoperative Karnofsky Performance Scale (KPS) scores and KPS scores at two weeks after operation. (iv) Follow-up data were obtained for the all patients: clinical outcomes including progression free survival (PFS) and overall survival (OS) time, which were mainly collected when patients visited the clinics or during phone interviews with patients and/or their relatives. (v) All patients had a staging evaluation that consisted of magnetic resonance imaging (MRI) scans of the neuro system
Astrocytomas are primary brain tumors of glial lineage and these are classified by the World Health Organization (WHO) into four grades (Louis et al, 2007)

Summary

Introduction

Malignant glioblastoma multiform (GBM, WHO grade IV) are the most malignant and prevalent intracranial tumor providing for well over one half of all gliomas (Hoffman et al, 2006; Schneider et al, 2010). GBM is characterized by a rapid growth and short time to progression in most treated patients. Despite recent advances in diagnostics and treatments, prognosis for advanced patients suffering from these diseases remains poor (Ng et al, 2007). It is important for us to understand the factors that contribute positively or negatively to the prognosis of patients, which may guide treatment paradigms and therapeutic strategies aimed at prolonging survival. Tumor molecular alteration has been taken into consideration in few studies (Gorlia et al, 2008; Li et al, 2008). Few studies are based on a large scale of Chinese GBM patients. In this retrospective study, we analyzed a large institutional series of Chinese patients with GBM to identify clinical., radiological., Immunohistochemistry and treatment factors influencing the clinical outcomes

Materials and Methods

Findings

Discussion