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Chen M, Huang L, Wang F, Xu X, Xu X. Competing Risk Model to Determine the Prognostic Factors for Patients with Gliosarcoma. World Neurosurg 2024; 183:e483-e494. [PMID: 38157982 DOI: 10.1016/j.wneu.2023.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Gliosarcoma (GSM) is a highly aggressive variant of brain cancer with an extremely unfavorable prognosis. Prognosis is not feasible by traditional methods because of a lack of staging criteria, and the present study aims to screen more detailed demographic factors to predict the prognostic factors of the tumors. METHODS For this study, we extracted data of patients diagnosed with GSM from the SEER (Surveillance Epidemiology and End Results) database between 2000 and 2019. To account for the influence of competing risks, we used a Cumulative Incidence Function. Subsequently, univariate analysis was conducted to evaluate the individual variables under investigation. Specifically for patients with GSM, we generated cumulative risk curves for specific mortality outcomes and events related to competing risks. In addition, we used both univariate and multivariate Cox analysis to account for non-GSM-related deaths that may confound our research. RESULTS The competing risk model showed that age, marital status, tumor size, and adjuvant therapy were prognostic factors in GSM-related death. The analysis results showed that older age (60-70 years, ≥71 years) and larger tumor size (≥5.3 cm) significantly increased the risk of GSM-related death. Conversely, surgical intervention, chemotherapy, and being single were identified as protective factors against GSM-related death. CONCLUSIONS Our study using a competing risk model provided valuable insights into the prognostic factors associated with GSM-related death. Further research and clinical interventions targeted at minimizing these risk factors and promoting the use of protective measures may contribute to improved outcomes and reduced mortality for patients with GSM.
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Affiliation(s)
- Mingyi Chen
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Liying Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Fang Wang
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaoxin Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaohong Xu
- Department of Neurology and Stroke Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China; Clinical Neuroscience Institute, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China.
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2
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Zhu E, Wang J, Shi W, Jing Q, Ai P, Shan D, Ai Z. Optimizing adjuvant treatment options for patients with glioblastoma. Front Neurol 2024; 15:1326591. [PMID: 38456152 PMCID: PMC10919147 DOI: 10.3389/fneur.2024.1326591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/09/2024] [Indexed: 03/09/2024] Open
Abstract
Background This study focused on minimizing the costs and toxic effects associated with unnecessary chemotherapy. We sought to optimize the adjuvant therapy strategy, choosing between radiotherapy (RT) and chemoradiotherapy (CRT), for patients based on their specific characteristics. This selection process utilized an innovative deep learning method. Methods We trained six machine learning (ML) models to advise on the most suitable treatment for glioblastoma (GBM) patients. To assess the protective efficacy of these ML models, we employed various metrics: hazards ratio (HR), inverse probability treatment weighting (IPTW)-adjusted HR (HRa), the difference in restricted mean survival time (dRMST), and the number needed to treat (NNT). Results The Balanced Individual Treatment Effect for Survival data (BITES) model emerged as the most effective, demonstrating significant protective benefits (HR: 0.53, 95% CI, 0.48-0.60; IPTW-adjusted HR: 0.65, 95% CI, 0.55-0.78; dRMST: 7.92, 95% CI, 7.81-8.15; NNT: 1.67, 95% CI, 1.24-2.41). Patients whose treatment aligned with BITES recommendations exhibited notably better survival rates compared to those who received different treatments, both before and after IPTW adjustment. In the CRT-recommended group, a significant survival advantage was observed when choosing CRT over RT (p < 0.001). However, this was not the case in the RT-recommended group (p = 0.06). Males, older patients, and those whose tumor invasion is confined to the ventricular system were more frequently advised to undergo RT. Conclusion Our study suggests that BITES can effectively identify GBM patients likely to benefit from CRT. These ML models show promise in transforming the complex heterogeneity of real-world clinical practice into precise, personalized treatment recommendations.
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Affiliation(s)
- Enzhao Zhu
- School of Medicine, Tongji University, Shanghai, China
| | - Jiayi Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Weizhong Shi
- Shanghai Hospital Development Center, Shanghai, China
| | - Qi Jing
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Pu Ai
- School of Medicine, Tongji University, Shanghai, China
| | - Dan Shan
- Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Zisheng Ai
- Department of Medical Statistics, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Mental Disorders, Chinese-German Institute of Mental Health, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
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Hu S, Sun C, Chen M, Zhou J. Marital Status as an Independent Prognostic Factor in Patients with Glioblastoma: A Population-Based Study. World Neurosurg 2024; 182:e559-e569. [PMID: 38061540 DOI: 10.1016/j.wneu.2023.11.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND This study was aimed to investigate the effects of marital status on overall survival (OS) and cancer-specific survival (CSS) in patients with glioblastoma (GBM) and to develop nomograms for predicting prognosis in GBM patients. METHODS All patients were selected from the Surveillance, Epidemiology, and End Results cancer registry program. We used propensity score matching to balance the baseline characteristics of married and unmarried patients. The effects of marital status on OS and CSS were then assessed using Kaplan-Meier curves and Cox proportional hazard regression, and the magnitude of each factor was visualized in the form of forest maps. The impact of marriage on the survival of GBM patients was further explored by stratifying several demographic factors. Finally, the nomograms were constructed and verified based on Cox proportional risk regression model. RESULTS A total of 17,517 patients with GBM (11,818 married patients, 67.5%) were enrolled in the study cohort. After propensity score matching, there were 5699 patients in both the married and unmarried groups. Multivariate Cox regression analysis showed that both married and single patients had better OS (married: hazard ratio [HR] 0.824, 95% confidence interval [CI]: 0.788-0.862, P < 0.001; single: HR 0.764, 95% CI: 0.722-0.808, P < 0.001) and CSS (married: HR 0.833, 95% CI: 0.796-0.872, P < 0.001; single: HR 0.761, 95% CI: 0.718-0.806, P < 0.001) than divorced, separated, and widowed patients. CONCLUSIONS Marital status was an independent prognostic factor in patients with GBM. The nomograms constructed in this study could help medical professionals to provide personalized prognostic assessment and treatment decisions for patients with GBM.
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Affiliation(s)
- Shaobo Hu
- Department of Neurosurgery, The Affiliated Li Huili Hospital, Ningbo University, Ningbo, Zhejiang, China.
| | - Chengfeng Sun
- Department of Neurosurgery, The Affiliated Li Huili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Maosong Chen
- Department of Neurosurgery, The Affiliated Li Huili Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Jiang Zhou
- Department of Neurosurgery, The Affiliated Li Huili Hospital, Ningbo University, Ningbo, Zhejiang, China
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Baumgarten P, Prange G, Kamp MA, Monden D, Neef V, Schwarzer F, Dubinski D, Dinc N, Weber KJ, Czabanka M, Hattingen E, Ronellenfitsch MW, Steinbach JP, Senft C. Treatment of very elderly glioblastoma patients ≥ 75 years of age: whom to treat. J Neurooncol 2023; 165:509-515. [PMID: 38032426 PMCID: PMC10752837 DOI: 10.1007/s11060-023-04518-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023]
Abstract
PURPOSE The prognosis of patients ≥ 75 years suffering from glioblastoma is poor. Novel therapies are usually reserved for patients ≤ 70 years. In an aging population, treatment of very elderly patients remains a challenge. METHODS Between 2010 and 2018, a total of 977 glioblastoma patients were treated at our institution. Of these, 143 patients were ≥ 75 years at diagnosis. Primary procedure was surgical resection or biopsy followed by adjuvant treatment, whenever possible. We retrospectively investigated overall survival (OS) and potential prognostic factors influencing survival, including Karnofsky Performance Status (KPS), surgical therapy, adjuvant therapy as well as MGMT promotor status. RESULTS In very elderly patients, median age was 79 years (range: 75-110). Biopsy only was performed in 104 patients; resection was performed in 39 patients. Median OS for the entire cohort was 5.9 months. Univariate analysis showed that KPS at presentation (≥ 70 vs. ≤60), surgery vs. biopsy, adjuvant chemotherapy and adjuvant radiotherapy were significantly associated with OS (6 vs. 3, p < 0.0111; 12 vs. 4, p = 0.0011; 11 vs. 4, p = 0.0003 and 10 vs. 1.5 months, p < 0.0001, respectively). Multivariate analysis confirmed adjuvant radiotherapy (p < 0.0001) and chemotherapy (p = 0.0002) as independent factors influencing OS. CONCLUSION For very elderly patients, the natural course of disease without treatment is devastating. These patients benefit from multimodal treatment including adjuvant radiotherapy and chemotherapy. A beneficial effect of resection has not been demonstrated. Treatment options and outcomes should be thoughtfully discussed before treatment decisions are made.
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Affiliation(s)
- Peter Baumgarten
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany.
| | - Georg Prange
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Centre for Palliative and Neuro-palliative Care, Brandenburg Medical School Theodor Fontane and Faculty of Health Sciences Brandenburg, Campus Rüdersdorf, Rüdersdorf bei Berlin, Germany
| | - Daniel Monden
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Vanessa Neef
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Franziska Schwarzer
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Medicine Rostock, Rostock, Germany
| | - Nazife Dinc
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Jena, Germany
| | - Katharina J Weber
- Neurological Institute (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- German Cancer Consortium (DKTK), partner site Frankfurt/Mainz, Frankfurt, Germany
- German Cancer Research Center (DKFZ), Heidelberg, Germany
- Frankfurt Cancer Institute (FCI), Goethe University, Frankfurt, Germany
- University Cancer Center (UCT), Goethe University Hospital, Frankfurt, Germany
| | - Markus Czabanka
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Elke Hattingen
- Department of Neuroradiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Michael W Ronellenfitsch
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Joachim P Steinbach
- Department of Neuro-Oncology, University Hospital Frankfurt - Goethe-University, Frankfurt, Germany
| | - Christian Senft
- Department of Neurosurgery, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
- Department of Neurosurgery, University Hospital Jena, Friedrich Schiller University, Am Klinikum 1, D-07747, Jena, Germany
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Stoll E, Hader M, Rückert M, Weissmann T, Lettmaier S, Putz F, Hecht M, Fietkau R, Rosin A, Frey B, Gaipl US. Detailed in vitro analyses of the impact of multimodal cancer therapy with hyperthermia and radiotherapy on the immune phenotype of human glioblastoma cells. Int J Hyperthermia 2022; 39:796-805. [PMID: 35676615 DOI: 10.1080/02656736.2022.2080873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Improvements of heat-delivery systems have led to hyperthermia (HT) being increasingly recognized as an adjunct treatment modality also for brain tumors. But how HT affects the immune phenotype of glioblastoma cells is only scarcely known. MATERIALS AND METHODS We therefore investigated the effect of in vitro HT, radiotherapy (RT), and the combination of both (RHT) on cell death modalities, immune checkpoint molecule (ICM) expression and release of the danger signal HSP70 of two human glioblastoma cell lines (U87 and U251) by using multicolor flow cytometry and ELISA. Hyperthermia was performed once or twice for 60-minute sessions reaching temperatures of 39 °C, 41 °C, and 44 °C, respectively. RT was administered with 5 x 2 Gy. RESULTS A hyperthermia chamber for cell culture t-flasks regulating the temperature via a contact sensor was developed. While the glioblastoma cells were rather radioresistant, particularly in U251 cells, the combination of RT with HT significantly increased the percentage of apoptotic and necrotic cells for all temperatures examined and for both, single and double HT application. In line with that, an increased release of HSP 70 was seen only in U251 cells, mainly following treatment with HT at temperatures of 44 °C alone or in combination with RT. In contrast, immune suppressive (PD-L1, PD-L2, HVEM) and immune stimulatory (ICOS-L, CD137-L and Ox40-L) ICMs were significantly increased mostly on U87 cells, and particularly after RHT with 41 °C. CONCLUSIONS Individual assessment of the glioblastoma immune cell phenotype with regard to the planned treatment is mandatory to optimize multimodal radio-immunotherapy protocols including HT.
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Affiliation(s)
- Eileen Stoll
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Hader
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Rückert
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Thomas Weissmann
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Sebastian Lettmaier
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Florian Putz
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Markus Hecht
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Andreas Rosin
- Chair for Ceramic Materials Engineering, Keylab Glastechnology, University of Bayreuth, Bayreuth, Germany
| | - Benjamin Frey
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Udo S Gaipl
- Translational Radiobiology, Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.,Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Hong MAC, Omar AT, Khu KJO. Socioeconomic factors affecting survivorship of glioblastoma patients in the Philippines. J Clin Neurosci 2022; 98:89-95. [PMID: 35151062 DOI: 10.1016/j.jocn.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 10/19/2022]
Abstract
Glioblastoma (GBM) is the most common malignant primary brain tumor in adults worldwide. However, data on the survivorship of GBM patients in low- and middle-income countries is sparse. We determined whether socioeconomic factors such as marital status, place of residence, educational attainment, employment status, and income affected survival. A retrospective cohort study of surgically managed GBM patients (n = 48) in a single center over a five-year period was conducted using chart review and telephone interview. The mean age was 41 years, with a male predilection (62%). Most patients were married (73%), employed full time (79%), resided in a rural location (56%), completed secondary education (44%), and had a low income (83%). Most of the tumors were > 5 cm at the time of diagnosis (90%) and involved more than one lobe (40%). Majority underwent subtotal resection (56%). Only 15% (n = 7) had adjuvant chemoradiation while 23% (n = 11) had radiotherapy alone. Median overall survival was 7.6 months. Multivariate analysis showed that extent of resection (gross total resection, p = 0.0033; subtotal resection, p = 0.0069) and adjuvant treatment (p = 0.0254) were associated with improved survival, while low income (p = 0.0178) and educational (p = 0.0206) levels and part-time employment (p = 0.0063) were associated with decreased survival. Many GBM patients at our center presented at an advanced stage in their natural history, and majority (62%) did not receive adjuvant treatment after surgery. As such, the median overall survival was less than that reported in developed countries. Of the socioeconomic factors analyzed, low income and educational levels and part-time employment were negatively associated with survivorship.
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Affiliation(s)
- Manilyn Ann C Hong
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines
| | - Abdelsimar T Omar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Philippines.
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Goldman DA, Reiner AS, Diamond EL, DeAngelis LM, Tabar V, Panageas KS. Lack of survival advantage among re-resected elderly glioblastoma patients: a SEER-Medicare study. Neurooncol Adv 2021; 3:vdaa159. [PMID: 33506202 PMCID: PMC7813163 DOI: 10.1093/noajnl/vdaa159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The survival benefit of re-resection for glioblastoma (GBM) remains controversial, owing to the immortal time bias inadequately considered in many studies where re-resection was treated as a fixed, rather than a time-dependent factor. Using the Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) database, we assessed treatment patterns for older adults and evaluated the association between re-resection and overall survival (OS), accounting for the timing of re-resection. METHODS This retrospective cohort study included elderly patients (age ≥66) in the SEER-Medicare linked database diagnosed with GBM between 2006 and 2015 who underwent initial resection. Time-dependent Cox regression was used to assess the association between re-resection and OS, controlling for age, gender, race, poverty level, geographic region, marital status, comorbidities, receipt of radiation + temozolomide, and surgical complications. RESULTS Our analysis included 3604 patients with median age 74 (range: 66-96); 54% were men and 94% were white. After initial resection, 44% received radiation + temozolomide and these patients had a lower hazard of death (hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.26-0.31, P < .001). In total, 9.5% (n = 343) underwent re-resection. In multivariable analyses, no survival benefit was seen for patients who underwent re-resection (HR: 1.12, 95% CI: 0.99-1.27, P = .07). CONCLUSIONS Re-resection rates were low among elderly GBM patients, and no survival advantage was observed for patients who underwent re-resection. However, patients who received standard of care at initial diagnosis had a lower risk of death. Older adults benefit from receiving radiation + temozolomide after initial resection, and future studies should assess the relationship between re-resection and OS taking the time of re-resection into account.
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Affiliation(s)
- Debra A Goldman
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Anne S Reiner
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Eli L Diamond
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lisa M DeAngelis
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Viviane Tabar
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katherine S Panageas
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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8
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Berger K, Turowski B, Felsberg J, Malzkorn B, Reifenberger G, Steiger HJ, Budach W, Haussmann J, Knipps J, Rapp M, Hänggi D, Sabel M, Mijderwijk HJ, Kamp MA. Age-stratified clinical performance and survival of patients with IDH-wildtype glioblastoma homogeneously treated by radiotherapy with concomitant and maintenance temozolomide. J Cancer Res Clin Oncol 2020; 147:253-262. [PMID: 32748120 PMCID: PMC7810639 DOI: 10.1007/s00432-020-03334-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/22/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Isocitrate dehydrogenase (IDH)-wildtype glioblastomas are the most malignant glial tumours. Median survival is only 14-16 months after diagnosis, with patients aged ≥ 65 years reportedly showing worse outcome. This study aimed to further evaluate the prognostic role of age in a homogenously treated patient cohort. METHODS The study includes 132 IDH-wildtype glioblastoma patients treated between 2013 and 2017 with open resection followed by radiotherapy with concomitant and maintenance temozolomide. Patients were dichotomized into a non-elderly (< 65 years) and an elderly (≥ 65 years) group. Extent of resection and the O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation status were determined for each tumour. Clinical and radiological follow-up data were obtained at 6 weeks after the end of radiation therapy and thereafter in 3-month intervals. Progression-free survival (PFS) and overall survival (OS) were evaluated in univariate and multivariate cox regression analyses. RESULTS The elderly group consisted of 58 patients (median age: 70.5 years) and the non-elderly group of 74 patients (median age: 55 years). Median pre- and postoperative operative Karnofsky Performance Scale (KPS), Eastern Cooperative Oncology Group (ECOG) score and National Institutes of Stroke Scale (NIHSS) were not significantly different between the groups, but KPS and ECOG scores became significantly worse in the elderly group at 6 weeks after termination of radiation therapy. Neither PFS nor OS differed significantly between the age groups. Patients with MGMT promoter-methylated tumours survived longer. CONCLUSION Elderly patients in good pre- and postoperative clinical conditions may show similar outcome as younger patients when treated according to standard of care. However, elderly patients may suffer more frequently from clinical deterioration following chemoradiotherapy. In both age groups, MGMT promoter methylation was linked to longer PFS and OS.
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Affiliation(s)
- Kerstin Berger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Bernd Turowski
- Institute for Diagnostic and Interventional Radiology, Frankfurt, Germany
| | | | | | | | - Hans-Jakob Steiger
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Jan Haussmann
- Department of Radiation Oncology, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Johannes Knipps
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marion Rapp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Daniel Hänggi
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Michael Sabel
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Hendrik-Jan Mijderwijk
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Marcel A Kamp
- Department of Neurosurgery, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Depression and glioblastoma, complicated concomitant diseases: a systemic review of published literature. Neurosurg Rev 2018; 43:497-511. [PMID: 30094499 DOI: 10.1007/s10143-018-1017-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/09/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023]
Abstract
Glioblastoma multiforme (GBM) is the most common primary brain cancer. Depression is a common co-morbidity of this condition. Despite this common interaction, relatively little research has been performed on the development of GBM-associated depression. We performed a literary search of the PubMed database for articles published relating to GBM and depression. A total of 85 articles were identified with 46 meeting inclusion criteria. Depression significantly impacts care, decreasing medication compliance, and patient survival. Diagnostically, because depression and GBM share intricate neuro-connectivity in a way that effect functionality, these diseases can be mistaken for alternative psychological or pathological disorders, complicating care. Therapeutically, anti-depressants have anti-tumor properties; yet, some have been shown to interfere with GBM treatment. One reason for this is that the pathophysiological development of depression and GBM share several pathways including altered regulation of the 5-HT receptor, norepinephrine, and 3':5'-cyclic monophosphate. Over time, depression can persist after GBM treatment, affecting patient quality of life. Together, depression and GBM are complicated concomitant diseases. Clinicians must be aware of their co-existence. Because of overlapping molecular pathways involved in both diseases, careful medication selection is imperative to avoid potential adverse interactions. Since GBMs are the most common primary brain cancer, physicians dealing with this disease should be prepared for the development of depression as a potential sequela of this condition, given the related pathophysiology and the known poor outcomes.
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Factors predicting intolerance to definitive conventional radiotherapy in geriatric patients. Strahlenther Onkol 2018; 194:894-903. [DOI: 10.1007/s00066-018-1318-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/08/2018] [Indexed: 12/22/2022]
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Franceschi E, Tosoni A, Minichillo S, Depenni R, Paccapelo A, Bartolini S, Michiara M, Pavesi G, Urbini B, Crisi G, Cavallo MA, Tosatto L, Dazzi C, Biasini C, Pasini G, Balestrini D, Zanelli F, Ramponi V, Fioravanti A, Giombelli E, De Biase D, Baruzzi A, Brandes AA. The Prognostic Roles of Gender and O6-Methylguanine-DNA Methyltransferase Methylation Status in Glioblastoma Patients: The Female Power. World Neurosurg 2018; 112:e342-e347. [PMID: 29337169 DOI: 10.1016/j.wneu.2018.01.045] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/04/2018] [Accepted: 01/05/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clinical and molecular factors are essential to define the prognosis in patients with glioblastoma (GBM). O6-methylguanine-DNA methyltransferase (MGMT) methylation status, age, Karnofsky Performance Status (KPS), and extent of surgical resection are the most relevant prognostic factors. Our investigation of the role of gender in predicting prognosis shows a slight survival advantage for female patients. METHODS We performed a prospective evaluation of the Project of Emilia Romagna on Neuro-Oncology (PERNO) registry to identify prognostic factors in patients with GBM who received standard treatment. RESULTS A total of 169 patients (99 males [58.6%] and 70 females [41.4%]) were evaluated prospectively. MGMT methylation was evaluable in 140 patients. Among the male patients, 36 were MGMT methylated (25.7%) and 47 were unmethylated (33.6%); among the female patients, 32 were methylated (22.9%) and 25 were unmethylated (17.9%). Survival was longer in the methylated females compared with the methylated males (P = 0.028) but was not significantly different between the unmethylated females and the unmethylated males (P = 0.395). In multivariate analysis, gender and MGMT methylation status considered together (methylated females vs. methylated males; hazard ratio [HR], 0.459; 95% confidence interval [CI], 0.242-0.827; P = 0.017), age (HR, 1.025; 95% CI, 1.002-1.049; P = 0.032), and KPS (HR, 0.965; 95% CI, 0.948-0.982; P < 0.001) were significantly correlated with survival. CONCLUSIONS Survival was consistently longer among MGMT methylated females compared with males. Gender can be considered as a further prognostic factor.
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Affiliation(s)
- Enrico Franceschi
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Alicia Tosoni
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Santino Minichillo
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Roberta Depenni
- Department of Oncology, Hematology, and Respiratory Diseases, University Hospital of Modena, Modena, Italy
| | - Alexandro Paccapelo
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Stefania Bartolini
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Maria Michiara
- Department of Medical Oncology, University Hospital of Parma, Parma, Italy
| | - Giacomo Pavesi
- Department of Neurosurgery, Agostino-Estense Hospital, Modena, Italy; Department of Oncology and Hematology, Romagnolo Scientific Institute for the Study and Treatment of Tumors-IRCCS, Cesena, Italy
| | - Benedetta Urbini
- Clinical Oncology Unit, St. Anna University Hospital, Ferrara, Italy
| | - Girolamo Crisi
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Michele A Cavallo
- Department of Neurosurgery, St. Anna University Hospital, Ferrara, Italy
| | - Luigino Tosatto
- Department of Neurosurgery, M. Bufalini Hospital, Cesena, Italy
| | - Claudio Dazzi
- Department of Oncology and Hematology, General Hospital, Ravenna, Italy
| | - Claudia Biasini
- Department of Oncology and Hematology, Oncology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Giuseppe Pasini
- Department of Medical Oncology, Infermi Hospital, Rimini, Italy
| | | | - Francesca Zanelli
- Department of Oncology, Santa Maria Nuova Hospital-IRCCS, Reggio Emilia, Italy
| | - Vania Ramponi
- Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Antonio Fioravanti
- Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Ermanno Giombelli
- Department of Special Surgeries, Unit of Neurosurgery, University Hospital of Parma, Parma, Italy
| | - Dario De Biase
- Molecular Diagnostic Unit, Department of Pharmacy and Biotechnology, USL Company of Bologna, University of Bologna, Bologna, Italy
| | - Agostino Baruzzi
- IRCCS Institute of Neurological Sciences, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Alba A Brandes
- Department of Medical Oncology, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy.
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Peeken JC, Hesse J, Haller B, Kessel KA, Nüsslin F, Combs SE. Semantic imaging features predict disease progression and survival in glioblastoma multiforme patients. Strahlenther Onkol 2018; 194:580-590. [PMID: 29442128 DOI: 10.1007/s00066-018-1276-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/29/2018] [Indexed: 01/20/2023]
Abstract
BACKGROUND For glioblastoma (GBM), multiple prognostic factors have been identified. Semantic imaging features were shown to be predictive for survival prediction. No similar data have been generated for the prediction of progression. The aim of this study was to assess the predictive value of the semantic visually accessable REMBRANDT [repository for molecular brain neoplasia data] images (VASARI) imaging feature set for progression and survival, and the creation of joint prognostic models in combination with clinical and pathological information. METHODS 189 patients were retrospectively analyzed. Age, Karnofsky performance status, gender, and MGMT promoter methylation and IDH mutation status were assessed. VASARI features were determined on pre- and postoperative MRIs. Predictive potential was assessed with univariate analyses and Kaplan-Meier survival curves. Following variable selection and resampling, multivariate Cox regression models were created. Predictive performance was tested on patient test sets and compared between groups. The frequency of selection for single variables and variable pairs was determined. RESULTS For progression free survival (PFS) and overall survival (OS), univariate significant associations were shown for 9 and 10 VASARI features, respectively. Multivariate models yielded concordance indices significantly different from random for the clinical, imaging, combined, and combined + MGMT models of 0.657, 0.636, 0.694, and 0.716 for OS, and 0.602, 0.604, 0.633, and 0.643 for PFS. "Multilocality," "deep white-matter invasion," "satellites," and "ependymal invasion" were over proportionally selected for multivariate model generation, underlining their importance. CONCLUSIONS We demonstrated a predictive value of several qualitative imaging features for progression and survival. The performance of prognostic models was increased by combining clinical, pathological, and imaging features.
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Affiliation(s)
- Jan C Peeken
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany. .,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany.
| | - Josefine Hesse
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Bernhard Haller
- Institut for Medical Statistics and Epidemiology, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Kerstin A Kessel
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Institut for Medical Statistics and Epidemiology, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
| | - Fridtjof Nüsslin
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Straße 22, 81675, Munich, Germany.,Institute of Innovative Radiotherapy (iRT), Department of Radiation Sciences (DRS), Helmholtz Zentrum München, Ingolstaedter Landstraße 1, 85764, Neuherberg, Germany.,Deutsches Konsortium für Translationale Krebsforschung (DKTK), Partner Site Munich, Munich, Germany
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Complementary and alternative medicine in radiation oncology. Strahlenther Onkol 2017; 193:419-425. [DOI: 10.1007/s00066-017-1101-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
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Vignot S, André T, Gonçalves A, Guièze R, Magné N, Orbach D, Penel N, Thariat J, Wislez M, Bay JO. [Which recent results in Oncology and Hematology will have an impact on our practices? The point of vue of Bulletin du Cancer editorial board]. Bull Cancer 2016; 104:6-19. [PMID: 28007296 DOI: 10.1016/j.bulcan.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 11/14/2016] [Indexed: 01/05/2023]
Abstract
Among the results presented at international congresses or published in scientific journals, which are those that have a real impact on daily practice? Every year, the editorial board of the Bulletin du Cancer proposes a selection of key data in oncology and hematology. The objective is to discuss results that change or reinforce the strategies in 2016 but also identify key information for our reflections in 2017.
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Affiliation(s)
- Stéphane Vignot
- Institut Jean-Godinot, département d'oncologie, 1, rue du Général-Koenig, 51726 Reims cedex, France.
| | - Thierry André
- Hôpital Saint-Antoine, service d'oncologie, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, département d'oncologie médicale, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Romain Guièze
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Daniel Orbach
- Institut Curie, département de pédiatrie, adolescents et jeunes adultes, rue d'Ulm, 75005 Paris, France
| | - Nicolas Penel
- Centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - Juliette Thariat
- Centre Antoine-Lacassagne, département de radiothérapie, 33, avenue Valombrose, 06189 Nice, France
| | - Marie Wislez
- Hôpital Tenon, service de pneumologie, 4, rue de la Chine, 75020 Paris, France
| | - Jacques-Olivier Bay
- CHU de Clermont-Ferrand, service de thérapie cellulaire et d'hématologie clinique adulte, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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