Abstract
Glioblastoma is a solid, infiltrating, and the most frequent highly malignant primary brain tumor. Our aim was to find the correlation between sex, age, preoperative Karnofsky performance status (KPS), presenting with seizures, and extent of resection (EOR) with overall survival (OS), progression-free survival (PFS), and postoperative KPS, along with the prognostic value of IDH1, MGMT, ATRX, EGFR, and TP53 genes mutations and of Ki67 through the analysis of a single-operator series in order to avoid the biases of a multi-operator series, such as the lack of homogeneity in surgical and adjuvant nonsurgical treatments. A randomized retrospective analysis of 122 patients treated by a single first operator at Sapienza University of Rome was carried out. After surgery, patients followed standard Stupp protocol treatment. Exclusion criteria were: (1) patients with primary brainstem and spinal cord gliomas and (2) patients who underwent partial resections (resection < 90%) or a biopsy exclusively for diagnostic purposes. Statistical analysis with a simultaneous regression model was carried out through the use of SPSS 25® (IBM). Results showed statistically significant survival increase in four groups: (1) patients treated with gross total resection (GTR) (p < 0.030); (2) patients with mutation of IDH1 (p < 0.0161); (3) patients with methylated MGMT promoter (p < 0.005); (4) patients without EGFR amplification or EGFRvIII mutation (p < 0.035). Higher but not statistically significant survival rates were also observed in: patients <75 years, patients presenting with seizures at diagnosis, patients affected by lesions in noneloquent areas, as well as in patients with ATRX gene mutation and Ki-67 < 10%.
Highlights
Glioblastoma (GBM) is a solid, infiltrating, highly malignant tumor, and a grade IV glioma according to 2016 World Health Organization (WHO) classification [1]
Of 23.46 months (STD 17.71), progression-free survival (PFS) 8.70 months (STD 12.10), and postoperative Karnofsky performance status (KPS) of 79.10 (STD 19.43), while 36.36% was female with an average age of 60.31 years (STD 12.18), average overall survival (OS) of 24.12 (STD 20.77), PFS 12.06 (STD 11.06), and postoperative KPS of 81.87 (STD 9.81)
Patients under years of age had an OS of 22.76 months (STD 13.59), a PFS of 9.61 months (STD 9.83), a preoperative KPS of 83.07 (STD 23.93), and a postoperative KPS of 82.06 (STD 17.02); patients aged to 75 years had an OS of 26.19 months (STD 21.74), a PFS of 11.11 (STD 13.71), a preoperative KPS of 84.4 (STD 11.48), and an average postoperative KPS of 78.26 (STD 17.6); patients over 75 years of age had an OS of 13.80 months (STD 6.41), a PFS of 4.40 months (STD 1.81), a preoperative KPS of 78 (STD 8.36), and a postoperative KPS of 84 (STD 5.47), Figure 1
Summary
Glioblastoma (GBM) is a solid, infiltrating, highly malignant tumor, and a grade IV glioma according to 2016 World Health Organization (WHO) classification [1]. It is believed that GBM is derived from a small population of cancer cells known as glioma stem cells (GSCs) and that these derive from the uncontrolled proliferation of neuronal stem cells (NSCs) residing in restricted germinal areas: ventricular subependymal zone of the temporal horn of the lateral ventricle (SVZ), the subgranular zone of the dentate gyrus of the hippocampus (SGZ), and of the white subcortical substance [2] It is the most frequent malignant primary brain tumor (16% of all primitives of the CNS and 54% of glial tumors) [3,4]. Standard treatment provides for maximum surgical resection followed by conformational radiotherapy (~60 Gy/30 fractions) for up to six weeks, concomitant with temozolomide (75 mg/m2 /day) and maintenance therapy with standard temozolomide schedule
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