Gonçalves João Meira, Ferreira Francisca, Carvalho Bruno, Polónia Patrícia, Linhares Paulo
Neurosurgery Department, Centro Hospitalar Universitário São João, Alameda Professor Hernâni Monteiro, 4200-319 Oporto, Portugal.
Faculty of Medicine, University of Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
Biomedicines. 2024 Oct 13;12(10):2327. doi: 10.3390/biomedicines12102327.
Glioblastoma is a challenge in neuro-oncology, with survival significantly influenced mainly by the extent of resection and molecular markers. Despite advancements, the prognosis for IDH-wildtype glioblastoma remains poor, particularly when surgical resection is not possible. However, some patients exhibit unexpectedly extended survival despite the extent of resection. This study aims to analyze the determinants that contribute to these atypical survival rates among glioblastoma patients who have had solely biopsy procedures. We conducted a retrospective analysis of patients diagnosed with IDH-wildtype glioblastomas at our institution from 2017 to 2021, who underwent biopsy only. This study focused on evaluating the impact of demographic characteristics, clinical features, molecular markers, and treatment modalities on survival outcomes (overall survival (OS) and progression-free survival (PFS)). Statistical analyses included survival analysis and logistic regression for evaluating associations between OS and pre-operative characteristics and post-operative treatments. The cohort included 99 patients, with a median age at diagnosis of 65.5 years. Median OS and PFS were 6.0 and 3.6 months, respectively. The multivariate analysis revealed that higher Karnofsky Performance Status (KPS) scores before biopsy, no contrast uptake on imaging, and any adjuvant therapy, particularly the use of bevacizumab, were independently associated to increased OS (HR = 0.97, = 0.009. HR = 0.7, = 0.015; HR = 0.27, = 0.002, respectively). Out of 99 patients, 77.8% survived past the 3-month threshold, with 87.0% of this receiving adjuvant treatment. Only 8% of patients survived past 24 months, and in this group of patients, methylation was observed in just 25% of cases. Kaplan-Meier analysis indicated a better prognosis with any type of adjuvant therapy across all patients, particularly so in those with KPS ≥ 70. Age did not significantly affect survival outcomes (OR = 1.00, = 0.835). Our findings reveal that any adjuvant treatment (whether chemotherapy and radiotherapy combined, chemotherapy alone, or bevacizumab), no contrast uptake on imaging, and higher pre-operative KPS are key determinants of survival in IDH-wildtype glioblastoma and should therefore be considered when deciding whether to perform a biopsy.
胶质母细胞瘤是神经肿瘤学中的一项挑战，其生存率主要受手术切除范围和分子标志物的显著影响。尽管取得了进展，但异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤的预后仍然很差，尤其是在无法进行手术切除时。然而，一些患者尽管手术切除范围有限，但生存期却意外延长。本研究旨在分析仅接受活检的胶质母细胞瘤患者中导致这些非典型生存率的决定因素。我们对2017年至2021年在本机构诊断为IDH野生型胶质母细胞瘤且仅接受活检的患者进行了回顾性分析。本研究重点评估人口统计学特征、临床特征、分子标志物和治疗方式对生存结果（总生存期（OS）和无进展生存期（PFS））的影响。统计分析包括生存分析和逻辑回归，以评估OS与术前特征和术后治疗之间的关联。该队列包括99名患者，诊断时的中位年龄为65.5岁。中位OS和PFS分别为6.0个月和3.6个月。多变量分析显示，活检前较高的卡氏功能状态（KPS）评分、影像学上无对比剂摄取以及任何辅助治疗，特别是贝伐单抗的使用，与OS延长独立相关（HR = 0.97，P = 0.009；HR = 0.7，P = 0.015；HR = 0.27，P = 0.002）。在99名患者中，77.8%存活超过3个月阈值，其中87.0%接受了辅助治疗。只有8%的患者存活超过24个月，在这组患者中，仅25%的病例观察到甲基化。Kaplan-Meier分析表明，所有患者接受任何类型的辅助治疗预后较好，尤其是KPS≥70的患者。年龄对生存结果无显著影响（OR = 1.00，P = 0.835）。我们的研究结果表明，任何辅助治疗（无论是化疗和放疗联合、单纯化疗还是贝伐单抗）、影像学上无对比剂摄取以及术前较高的KPS是IDH野生型胶质母细胞瘤生存的关键决定因素，并因此在决定是否进行活检时应予以考虑。
