Case Western Reserve University School of Medicine, 10900 Euclid Ave, Cleveland, OH, USA.
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH, USA.
Clin Neurol Neurosurg. 2020 Aug;195:106054. doi: 10.1016/j.clineuro.2020.106054. Epub 2020 Jun 29.
Gliosarcoma (GSM) is a rare subtype of glioblastoma (GBM) that accounts for approximately four percent of high-grade gliomas. There is scarce epidemiological data on patients with GSM as a distinct subgroup of GBM.
A systematic literature review was performed of peer-reviewed databases using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to evaluate the impact of race and ethnicity on survival in patients with GSM compared to patients with GBM.
Following initial abstract screening, a total of 138 articles pertaining to GSM and 275 pertaining to GBM met criteria for full-text review, with 5 and 27 articles included in the final analysis for GSM and GBM, respectively. The majority of patients in both cohorts were non-Hispanic Whites, representing 85.6 % of total GSM patients and 87.7 % of GBM patients analyzed. Two GSM studies stratified survival by race, with one reporting the longest median survival for the Hispanic population of 10.6 months and the shortest median survival for the Asian population of 9 months. Among the GBM studies analyzed, the majority of studies reported shorter survival and higher risk of mortality among White Non-Hispanics compared to non-White patients; and of the 15 studies which reported data for the Asian population, 12 studies reported this race category to have the longest survival compared to all other races studied. Younger age, female sex, MGMT promoter methylation status, and adjuvant chemoradiation therapy were associated with improved survival in both GSM and GBM cohorts, although these were not further stratified by race.
GSM portends a similarly poor prognosis to other GBM subtypes; however, few studies exist which have examined factors associated with differences in survival between these histologic variants. This review of the literature suggests there is a possible association between race and survival for patients with GBM, however data supporting this conclusion for patients with GSM is lacking. These findings suggest that GSM is a distinct disease from other GBM subtypes, with epidemiologic differences that should be further explored.
神经胶母肉瘤（GSM）是胶质母细胞瘤（GBM）的一种罕见亚型，约占高级别胶质瘤的 4%。关于 GSM 作为 GBM 的一个独特亚组患者的流行病学数据很少。
采用系统综述文献的方法，按照系统评价和荟萃分析的首选报告项目（PRISMA）指南，检索同行评审数据库，评估种族和民族对 GSM 患者与 GBM 患者生存的影响。
经过初步摘要筛选，共有 138 篇关于 GSM 的文章和 275 篇关于 GBM 的文章符合全文审查标准，其中 5 篇和 27 篇文章分别纳入 GSM 和 GBM 的最终分析。两个队列中的大多数患者都是非西班牙裔白人，占 GSM 患者总数的 85.6%和 GBM 患者的 87.7%。有两项 GSM 研究按种族分层了生存情况，其中一项报告西班牙裔人群的中位生存时间最长为 10.6 个月，亚洲人群的中位生存时间最短为 9 个月。在分析的 GBM 研究中，大多数研究报告说，与非白人患者相比，白人非西班牙裔患者的生存时间更短，死亡风险更高；在报告亚洲人群数据的 15 项研究中，有 12 项研究报告称，与研究的所有其他种族相比，该种族的生存时间最长。在 GSM 和 GBM 队列中，年龄较小、女性、MGMT 启动子甲基化状态和辅助放化疗与生存改善相关，尽管这些因素在种族方面没有进一步分层。
GSM 预示着与其他 GBM 亚型一样预后不良；然而，很少有研究检查了这些组织学变异体之间生存差异相关的因素。对文献的综述表明，GBM 患者的种族与生存之间可能存在关联，但缺乏支持 GSM 患者的结论的数据。这些发现表明，GSM 是一种与其他 GBM 亚型不同的疾病，具有应进一步探索的流行病学差异。
