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Improved 3-year survival rates for glioblastoma multiforme are associated with trends in treatment: analysis of the national cancer database from 2004 to 2013

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Abstract

Purpose

Glioblastoma multiforme (GBM) is a common and aggressive malignancy associated with poor prognosis. Characteristics and treatment of long-term survivors are of particular interest in efforts to improve outcomes. Therefore, the objective of this study was to examine trends and prognostic factors for 3-year survival from a national database.

Methods

The National Cancer Database (NCDB) was queried for patients diagnosed with cranial GBM from 2004 to 2013 and with 3-year follow-up. Trends in 3-year and overall survival, patient characteristics, tumor properties, and treatment modalities were examined. Multivariable logistic regression was utilized to investigate the association of these factors with 3-year survival. Predictor importance analysis was conducted using a metric defined as Wald χ2 penalized by degrees of freedom.

Results

A total of 88,919 GBM patients with 3-year follow-up were identified. Overall, 8757 (9.8%) patients survived ≥ 3 years. Three-year survival significantly improved from 8.0 to 10.5% (p < 0.001) from 2004 to 2013. Trimodal treatment administration also significantly increased from 38.7 to 55.9% (p < 0.001). During this span, patients increasingly presented as older (p = 0.040), without private insurance (p < 0.001), and with a higher comorbidity index (p < 0.001). On multivariable regression, factors such as trimodal treatment (p < 0.001), younger age (p < 0.001), and MGMT methylation (p < 0.001) were significantly associated with increased odds of 3-year survival. Predictor importance analysis indicated that MGMT methylation, age, and treatment modality were the most significant relative determinants of 3-year survival.

Conclusion

These findings illustrate an improved 3-year survival rate for GBM patients from 2004 to 2013 with a concurrent increase in trimodal treatment administration despite more adverse patient presenting characteristics.

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Funding

AQH was supported by the Mayo Clinic Professorship, the Mayo Clinic Clinician Investigator award, the Florida Department of Health Cancer Research Chair Fund, as well as the National Institutes of Health (R43CA221490, R01CA200399, R01CA195503, R01CA216855).

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Authors and Affiliations

  1. Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA

    Jad Zreik, F. M. Moinuddin, Yagiz U. Yolcu, Mohammed Ali Alvi & Mohamad Bydon

  2. Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA

    Kaisorn L. Chaichana & Alfredo Quinones-Hinojosa

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  1. Jad Zreik
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  2. F. M. Moinuddin
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11060_2020_3469_MOESM1_ESM.tiff

Supplementary file1—Supplementary Figure 1: Predictor importance analysis demonstrating the prognostic factors most predictive of three-year survival (TIFF 28129 kb)

11060_2020_3469_MOESM2_ESM.tiff

Supplementary file2—Supplementary Figure 2: Predictor importance analysis for patients with documented genetic testing demonstrating the prognostic factors most predictive of three-year survival (TIFF 28129 kb)

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Zreik, J., Moinuddin, F.M., Yolcu, Y.U. et al. Improved 3-year survival rates for glioblastoma multiforme are associated with trends in treatment: analysis of the national cancer database from 2004 to 2013. J Neurooncol 148, 69–79 (2020). https://doi.org/10.1007/s11060-020-03469-w

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