Mummareddy Nishit, Salwi Sanjana R, Ganesh Kumar Nishant, Zhao Zhiguo, Ye Fei, Le Chi H, Mobley Bret C, Thompson Reid C, Chambless Lola B, Mistry Akshitkumar M
School of Medicine, Vanderbilt University, Nashville, TN, United States.
Department of Surgery, Section of Plastic Surgery, University of Michigan Health System, Ann Arbor, MI, United States.
J Clin Neurosci. 2021 Feb;84:1-7. doi: 10.1016/j.jocn.2020.12.014. Epub 2020 Dec 28.
We conducted a segmental volumetric analysis of pre-operative brain magnetic resonance images (MRIs) of glioblastoma patients to identify brain- and tumor-related features that are prognostic of survival.
Using a dataset of 210 single-institutional adult glioblastoma patients, total volumes of the following tumor- and brain-related features were quantified on pre-operative MRIs using a fully automated segmentation tool: tumor enhancement, tumor non-enhancement, tumor necrosis, peri-tumoral edema, grey matter, white matter, and cerebrospinal fluid (CSF). Their association with survival using Cox regression models, adjusting for the well-known predictors of glioblastoma survival. The findings were verified in a second dataset consisting of 96 glioblastoma patients from The Cancer Imaging Archive and The Cancer Genome Atlas (TCIA/TCGA).
CSF volume and edema were independently and consistently associated with overall survival of glioblastoma patients in both datasets. Greater edema was associated with increased hazard or decreased survival [adjusted hazard ratio (aHR) with 95% confidence interval (CI): 1.34 [1.08-1.67], p = 0.008 (institutional dataset); and, 1.44 [1.08-1.93], p = 0.013 (TCIA/TCGA dataset)]. Greater CSF volume also correlated with increased hazard or decreased survival [aHR 1.27 [1.02-1.59], p = 0.035 (institutional dataset), and 1.42 [1.03-1.95], p = 0.032 (TCIA/TCGA dataset)].
Higher brain CSF volume and higher edema levels at diagnosis are independently associated with decreased survival in glioblastoma patients. These results highlight the importance of a broader, quantitative brain-wide radiological analyses and invite investigations to understand tumor-related causes of increased edema and possibly increased CSF volume.
我们对胶质母细胞瘤患者术前脑磁共振成像（MRI）进行了节段性容积分析，以确定与生存预后相关的脑和肿瘤特征。
使用一个包含210例单机构成年胶质母细胞瘤患者的数据集，使用全自动分割工具在术前MRI上对以下肿瘤和脑相关特征的总体积进行量化：肿瘤强化、肿瘤非强化、肿瘤坏死、瘤周水肿、灰质、白质和脑脊液（CSF）。使用Cox回归模型分析它们与生存的关联，并对胶质母细胞瘤生存的已知预测因素进行校正。研究结果在第二个数据集（由来自癌症成像存档和癌症基因组图谱（TCIA/TCGA）的96例胶质母细胞瘤患者组成）中得到验证。
在两个数据集中，脑脊液体积和水肿均与胶质母细胞瘤患者的总生存期独立且持续相关。水肿程度越高，风险增加或生存期缩短相关 [校正风险比（aHR）及95%置信区间（CI）：1.34 [1.08 - 1.67]，p = 0.008（机构数据集）；以及1.44 [1.08 - 1.93]，p = 0.013（TCIA/TCGA数据集）]。脑脊液体积越大也与风险增加或生存期缩短相关 [aHR 1.27 [1.02 - 1.59]，p = 0.035（机构数据集），以及1.42 [1.03 - 1.95]，p = 0.032（TCIA/TCGA数据集）]。
诊断时较高的脑脑脊液体积和较高的水肿水平与胶质母细胞瘤患者生存期缩短独立相关。这些结果突出了更广泛、定量的全脑放射学分析的重要性，并促使开展研究以了解水肿增加及可能的脑脊液体积增加的肿瘤相关原因。
