Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Surgery and Department of Biomedical Sciences, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Clin Neurol Neurosurg. 2020 Aug;195:105891. doi: 10.1016/j.clineuro.2020.105891. Epub 2020 May 7.
Multiple glioblastomas (GBM) are the uncommon presentation of the disease. We aimed to identify the variables associated with the survival of patients with multiple GBMs according to the updated WHO classification.
We retrospectively reviewed 173 patients with newly diagnosed GBM between January 2003 and December 2018 and analyzed patients with multiple lesions at the time of diagnosis. The clinical, radiographic, and biomarkers were evaluated for descriptive analysis. The median overall survival and the Kaplan-Meier curves of the multiple GBMs were estimated. Furthermore, the Cox proportional hazard regression was the estimated hazard ratio for death according to various factors. Moreover, Schoenfeld's global test was performed for estimating assumptions.
Of these, 30 (17.3%) of all GBMs were multiple GBMs, and multifocal and multicentric GBMs were found in 27 (90%) and 3 (10%), respectively. The median survival of the multiple GBMs was significantly shorter than solitary GBM (6 vs. 12 months, p = 0.003). Using Cox proportional hazards regression, the independent prognostic factors of multiple GBMs were concomitant Temozolomide with radiotherapy, wild-type IDH1, methylated MGMT promoter methylation in univariate analysis. In multivariable analysis, concomitant Temozolomide (TMZ) with radiotherapy (RT) was the strongest predictor associated with prognosis in multiple GBMs (0.40, 95%CI 0.16-0.97).
Multiple lesions are uncommon findings in glioblastoma with poor prognostic features. Concomitant TMZ with RT was the strongest predictor of prognosis. In the future., IDH1 mutation and MGMT promoter methylation should be further explored as prognostic factors.
多发胶质母细胞瘤（GBM）是该疾病的罕见表现。我们旨在根据世界卫生组织（WHO）最新分类，确定与多发 GBM 患者生存相关的变量。
我们回顾性分析了 2003 年 1 月至 2018 年 12 月期间新诊断为 GBM 的 173 例患者，并分析了诊断时存在多发病灶的患者。对临床、影像学和生物标志物进行描述性分析。估计多发性 GBM 的中位总生存期和 Kaplan-Meier 曲线。此外，还根据各种因素对 Cox 比例风险回归进行了估计死亡风险比。此外，还进行了 Schoenfeld 全局检验以估计假设。
在所有 GBM 中，30 例（17.3%）为多发 GBM，其中 27 例（90%）为多灶性 GBM，3 例（10%）为多中心性 GBM。多发 GBM 的中位生存期明显短于单发 GBM（6 个月 vs. 12 个月，p=0.003）。使用 Cox 比例风险回归，单因素分析中，同时使用替莫唑胺联合放疗、野生型 IDH1、甲基化 MGMT 启动子甲基化是多发 GBM 的独立预后因素。多变量分析中，同时使用替莫唑胺（TMZ）联合放疗（RT）是与多发 GBM 预后相关的最强预测因素（0.40，95%CI 0.16-0.97）。
多发病变是胶质母细胞瘤中预后较差的罕见表现。同时使用 TMZ 联合 RT 是预后的最强预测因素。未来，IDH1 突变和 MGMT 启动子甲基化应进一步作为预后因素进行探索。
