Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal.
Faculty of Medicine, Porto University, Porto, Portugal.
Cancer Causes Control. 2021 Apr;32(4):327-336. doi: 10.1007/s10552-020-01388-9. Epub 2021 Jan 15.
Glioblastoma prognosis remains dismal despite gross total removal (GTR) followed by chemoradiotherapy. Other known prognostic factors include functional status, age and IDH mutation status. However, to improve patient outcome, a search for other features with impact on survival is needed. We aimed to analyse the impact of body mass index (BMI) on overall survival (OS) and progression-free survival (PFS) of surgically resected primary glioblastoma and evaluate if BMI constitutes an independent prognostic factor.
We analysed all adult glioblastoma patients who underwent surgery and chemoradiotherapy between 2011 and 2017 at our institution. Overall survival was the study-primary endpoint, and progression-free survival-the secondary endpoint. We assayed age, gender, histology, extent of resection, IDH, functional and smoking status, cardiovascular risk factors, BMI, OS and PFS. Univariate analysis was conducted followed by multivariate analysis to establish independent prognostic factors. In accordance with the World Health Organization (WHO) BMI stratification, survival curves were obtained for normal-weight (18.5-24.9 kg/m), overweight (25-29.9 kg/m) and obese (≥ 30 kg/m) patient subgroups in addition to the non-obese (18.5-29.9 kg/m) population.
193 patients were evaluated, with a median follow-up time of 17.3 months. Median OS was 21.3 months in obese patients vs 16.2 months in the non-obese (p = 0.017) and 16 months in the normal weight (p = 0.007). Higher median OS was also observed in patients under 60 and those in which GTR was obtained. Median PFS in obese individuals was 9 months in comparison to 6 months in the normal-weight subgroup (p = 0.04) and 7 months in the non-obese (p = 0.050). Multivariate analysis identified age < 60 (p = 0.044), GTR (p = 0.004) and BMI ≥ 30 (p = 0.009) as independent prognostic factors for increased overall survival.
Higher BMI was associated with longer OS and PFS. Prospective studies are needed to validate these findings.
尽管在接受最大限度肿瘤切除（GTR）联合放化疗后，胶质母细胞瘤患者的预后仍较差。其他已知的预后因素包括功能状态、年龄和 IDH 突变状态。然而，为了改善患者的预后，需要寻找其他影响生存的特征。我们旨在分析体重指数（BMI）对手术切除的原发性胶质母细胞瘤患者总生存期（OS）和无进展生存期（PFS）的影响，并评估 BMI 是否构成独立的预后因素。
我们分析了 2011 年至 2017 年在我院接受手术和放化疗的所有成人胶质母细胞瘤患者。OS 是本研究的主要终点，PFS 是次要终点。我们检测了年龄、性别、组织学、切除程度、IDH、功能和吸烟状态、心血管危险因素、BMI、OS 和 PFS。进行单因素分析后，再进行多因素分析以确定独立的预后因素。根据世界卫生组织（WHO）的 BMI 分层，我们为正常体重（18.5-24.9kg/m2）、超重（25-29.9kg/m2）和肥胖（≥30kg/m2）患者亚组以及非肥胖（18.5-29.9kg/m2）人群获得了生存曲线。
共评估了 193 名患者，中位随访时间为 17.3 个月。肥胖患者的中位 OS 为 21.3 个月，而非肥胖患者为 16.2 个月（p=0.017），正常体重患者为 16 个月（p=0.007）。在年龄<60 岁和获得最大限度肿瘤切除的患者中，中位 OS 也较高。肥胖患者的中位 PFS 为 9 个月，而正常体重亚组为 6 个月（p=0.04），非肥胖亚组为 7 个月（p=0.050）。多因素分析确定年龄<60 岁（p=0.044）、最大限度肿瘤切除（p=0.004）和 BMI≥30（p=0.009）是 OS 延长的独立预后因素。
较高的 BMI 与较长的 OS 和 PFS 相关。需要前瞻性研究来验证这些发现。
