Department of Radiation Oncology, The James Cancer Hospital and Solove Research Institute at The Ohio State University Wexner Medical Center, Columbus, OH.
Department of Medicine, Baylor College of Medicine, Houston, TX.
Am J Clin Oncol. 2019 May;42(5):481-486. doi: 10.1097/COC.0000000000000537.
Determine the prognostic significance of rapid early tumor progression before radiation and chemotherapy for glioblastoma patients.
A retrospective review of glioblastoma patients was performed. Rapid early progression (REP) was defined as new enhancing tumor or >25% increase in enhancement before radiotherapy. The pre/postoperative magnetic resonance imaging was compared with the preradiation magnetic resonance imaging to determine REP. A blinded review of imaging was performed. Kaplan-Meier curves were generated to compare progression-free and overall survival (OS). Univariate analysis was performed using the log-rank test for categorical variables and Cox proportional hazards for continuous variables. Multivariable logistic regression was performed to assess factors related to early progression and Cox proportional hazards model was used for multivariate analysis of OS.
Eighty-seven patients met entry criteria. A total of 52% of patients developed REP. The OS in the REP group was 11.5 months (95% confidence interval [CI]: 7.4-17.6) and 20.1 months (95% CI: 17.8-26.1) without REP (P=0.013). On multivariate analysis including significant prognostic factors, presence of REP was found to increase the risk of death (hazard ratio: 2.104, 95% CI: 1.235-3.583, P=0.006). A total of 74% of patients recurred in the site of REP.
REP was common and independently predicted for a worse OS. Integrating REP with MGMT promotor methylation improved prognostic assessment. The site of REP was a common site of tumor progression. Our findings are hypothesis generating and may indicate a particular subset of glioblastoma patients who are resistant to current standard of care therapy. Further study to determine other molecular features of this group are underway.
确定胶质母细胞瘤患者在放化疗前快速早期肿瘤进展的预后意义。
对胶质母细胞瘤患者进行回顾性研究。快速早期进展（REP）定义为放疗前新出现增强肿瘤或增强程度增加>25%。通过比较术前和术后磁共振成像（MRI）来确定 REP。对影像进行盲法评估。生成 Kaplan-Meier 曲线以比较无进展生存期和总生存期（OS）。使用对数秩检验对分类变量进行单变量分析，对连续变量使用 Cox 比例风险进行单变量分析。进行多变量逻辑回归以评估与早期进展相关的因素，并使用 Cox 比例风险模型进行 OS 的多变量分析。
符合入组标准的患者共 87 例。共有 52%的患者发生 REP。REP 组的 OS 为 11.5 个月（95%置信区间[CI]：7.4-17.6），无 REP 组为 20.1 个月（95% CI：17.8-26.1）（P=0.013）。在包括显著预后因素的多变量分析中，发现存在 REP 会增加死亡风险（风险比：2.104，95% CI：1.235-3.583，P=0.006）。REP 部位共有 74%的患者复发。
REP 很常见，并且独立预测 OS 更差。将 REP 与 MGMT 启动子甲基化相结合可改善预后评估。REP 部位是肿瘤进展的常见部位。我们的研究结果是假设性的，可能表明当前标准治疗耐药的特定胶质母细胞瘤患者亚群。正在进行进一步的研究以确定该组的其他分子特征。
