From the Division of Clinical Neurooncology (S.K., L.L., M.G.), Department of Neurology (C.K.), West German Cancer Center (S.K., L.R., B.S., M.G.), and Department of Neurosurgery (L.R.), University Hospital Essen, University Duisburg-Essen; Division of Clinical Neurooncology, Department of Neurology and Center of Integrated Oncology (S.K., M.N., N.S., U.H., M.G.), and Institute for Medical Biometry, Informatics, and Epidemiology (R.F.), University of Bonn Medical Center; Department of Neuroradiology (E.H.), Goethe University Hospital, Frankfurt Am Main; Department of Otorhinolaryngology, Smell and Taste Clinic (T.H.), TU Dresden; DKFZ-Division Translational Neurooncology at the West German Cancer Center (S.K., B.S., M.G.), German Cancer Research Center (DKFZ), Heidelberg; and German Cancer Consortium (S.K., B.S., M.G.), Partner Site University Hospital Essen, Germany.
Neurology. 2020 Feb 4;94(5):e529-e537. doi: 10.1212/WNL.0000000000008744. Epub 2019 Dec 12.
To determine the role of olfactory function in patients with glioblastoma multiforme (GBM) as a prognostic clinical measure.
In a prospective case-control study, olfactory testing was performed in 73 patients with primary GBM at baseline during first-line treatment and at later follow-ups. An age-matched control cohort consisted of 49 patients with neurologic diseases, excluding those known to affect olfactory function per se. Depending on the olfactory testing score, patients were allotted to a hyposmia group (HG) or normosmia group (NG). MRI analysis was performed to assess whether tumor location affects olfactory pathways.
Patients with GBM had olfactory dysfunction significantly more often compared to the control cohort ( = 0.003). Tumor location could not explain this finding since no relevant difference in MRI-based olfactory pathway involvement was found between HG and NG ( = 0.131). Patients with olfactory dysfunction had significantly worse overall survival (OS) and progression-free survival (PFS) compared to those without dysfunction (median OS 20.9 vs 40.6 months, = 0.035; median PFS, 9 vs 19 months, = 0.022). Multivariate analysis in patients without MRI-based involvement of olfactory pathways confirmed olfaction is an independent prognostic factor for OS (hazard ratio [HR] 0.43; = 0.042) and PFS (HR 0.51; = 0.049).
This pilot study provides the first indication that olfactory dysfunction is frequently observed in GBM and may be associated with worse survival outcome in GBM. However, validation of these results in an independent cohort is needed.
确定嗅功能在多形性胶质母细胞瘤（GBM）患者中的作用，作为一种预后临床指标。
在一项前瞻性病例对照研究中，在一线治疗期间和后续随访中对 73 例原发性 GBM 患者进行基线嗅觉测试，纳入的患者年龄与对照组相匹配，共 49 例，为神经系统疾病患者，但不包括那些本身已知会影响嗅觉功能的疾病。根据嗅觉测试评分，将患者分为嗅觉减退组（HG）或嗅觉正常组（NG）。进行 MRI 分析，以评估肿瘤位置是否影响嗅觉通路。
与对照组相比，GBM 患者嗅觉功能障碍更为常见（ = 0.003）。肿瘤位置并不能解释这一发现，因为在 HG 和 NG 之间，基于 MRI 的嗅觉通路受累方面没有发现相关差异（ = 0.131）。与嗅觉功能正常的患者相比，有嗅觉功能障碍的患者的总生存期（OS）和无进展生存期（PFS）明显更差（中位 OS 20.9 与 40.6 个月， = 0.035；中位 PFS，9 与 19 个月， = 0.022）。在未行 MRI 评估的嗅觉通路受累患者中进行的多变量分析证实，嗅觉是 OS（风险比 [HR] 0.43； = 0.042）和 PFS（HR 0.51； = 0.049）的独立预后因素。
这项初步研究首次表明，嗅觉功能障碍在 GBM 中经常发生，并且可能与 GBM 的生存结局较差相关。但是，需要在独立队列中验证这些结果。
