Moon Hye Hyeon, Wongsawaeng Doonyaporn, Park Ji Eun, Park Seo Young, Baek Seunghee, Kim Young-Hoon, Song Sang Woo, Hong Chang-Ki, Kim Jeong Hoon, Lee Myung Hwan, Park Yae Won, Ahn Sung Soo, Pollock Jeffrey Michael, Barajas Ramon Francisco, Kim Ho Sung
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 43 Olympic-ro 88, Songpa-Gu, Seoul 05505, Korea.
Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Radiology. 2025 May;315(2):e241393. doi: 10.1148/radiol.241393.
Background Isocitrate dehydrogenase (IDH) wild-type glioblastoma often includes a noncontrast-enhanced tumor (NET) component, and the extent of NET resection may serve as a prognostic marker. Purpose To assess clinical outcomes based on gross total resection (GTR) of NET, develop a real-world survival model incorporating GTR-NET for IDH wild-type glioblastoma, and validate the findings in multinational external cohorts. Materials and Methods A retrospective analysis included patients with IDH wild-type glioblastoma in a prospective registry (March 2017 to October 2020) as the training set. External validation used consecutive patients from two centers (March 2017 to January 2023). Patients were stratified into three groups: GTR-NET, GTR in contrast-enhanced tumor (CET) only, and no GTR. A conditional inference tree (CIT) model was developed using GTR type, age, and O-methylguanine DNA methyltransferase () promoter methylation status to predict overall survival (OS) and was externally validated. Kaplan-Meier analysis, log-rank test, time-dependent area under the receiver operating characteristic curve, and Harrell C-indexes were used for evaluation. Results In the training set ( = 201; mean age, 60 years ± 11.3; 109 males), four survival groups were identified. GTR-NET was associated with longer OS (median, 32.6 months; IQR, 18.7-46.7 months; < .001). When GTR-NET was not achieved, OS was stratified as follows: younger than age 60 years (median OS, 23.4 months; IQR, 12.2-34.8 months), age 60 years or older and positive for (median OS, 19.1 months; IQR, 13.0-27.8 months), and age 60 years or older and negative for (median OS, 10.7 months; IQR, 6.5-14.1 months). External validation sets (352 patients in external validation set 1 and 60 patients external validation set 2) confirmed these groups ( < .001 and = .04). Time-dependent areas under the receiver operating characteristic curve ranged from 0.684 (95% CI: 0.623, 0.745) to 0.694 (95% CI: 0.631, 0.758) and from 0.610 (95% CI: 0.449, 0.771) to 0.678 (95% CI: 0.512, 0.844), with CIT sensitivity for GTR-NET at 70.7%-77.3% and 87.6%-87.9% and C-indexes of 0.65 and 0.63. Conclusion A GTR-NET-based survival model was developed and validated, demonstrating that GTR-NET is an independent prognostic marker for longer OS in IDH-wildtype glioblastoma. ClinicalTrials.gov identifier: NCT02619890 © RSNA, 2025
异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤通常包含非增强肿瘤（NET）成分，NET切除范围可能作为一种预后标志物。目的：基于NET的全切除（GTR）评估临床结局，建立一个纳入GTR-NET的IDH野生型胶质母细胞瘤真实世界生存模型，并在多国外部队列中验证研究结果。材料与方法：一项回顾性分析纳入了前瞻性登记研究（2017年3月至2020年10月）中的IDH野生型胶质母细胞瘤患者作为训练集。外部验证使用了来自两个中心（2017年3月至2023年1月）的连续患者。患者被分为三组：GTR-NET、仅对比增强肿瘤（CET）的GTR和未行GTR。使用GTR类型、年龄和O-甲基鸟嘌呤DNA甲基转移酶（）启动子甲基化状态建立一个条件推断树（CIT）模型来预测总生存期（OS），并进行外部验证。采用Kaplan-Meier分析、对数秩检验、受试者操作特征曲线下的时间依赖性面积以及Harrell C指数进行评估。结果：在训练集（n = 201；平均年龄，60岁±11.3；109例男性）中，确定了四个生存组。GTR-NET与更长的OS相关（中位数，32.6个月；IQR，18.7 - 46.7个月；P <.001）。当未实现GTR-NET时，OS分层如下：年龄小于60岁（中位OS，23.4个月；IQR，12.2 - 34.8个月）、年龄60岁及以上且（）阳性（中位OS，19.1个月；IQR，13.0 - 27.8个月）、年龄60岁及以上且（）阴性（中位OS，10.7个月；IQR，6.5 - 14.1个月）。外部验证集（外部验证集1中的352例患者和外部验证集2中的60例患者）证实了这些分组（P <.001和P =.04）。受试者操作特征曲线下的时间依赖性面积范围为0.684（95% CI：0.623，0.745）至0.694（95% CI：0.631，0.758）以及0.610（95% CI：0.449，0.771）至0.678（95% CI：0.512，0.844），CIT对GTR-NET的敏感性为70.7% - 77.3%和87.6% - 87.9%，C指数分别为0.65和0.63。结论：建立并验证了一个基于GTR-NET的生存模型，表明GTR-NET是IDH野生型胶质母细胞瘤患者OS更长的独立预后标志物。ClinicalTrials.gov标识符：NCT02619890 © RSNA，2025
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