ORIGINAL ARTICLE   

Journal of Neurosurgical Sciences 2022 June;66(3):173-86

DOI: 10.23736/S0390-5616.20.04850-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Glioblastoma: from volumetric analysis to molecular predictors

Tamara IUS ¹ ✉, Fabrizio PIGNOTTI ², Giuseppe M. DELLA PEPA ², Daniele BAGATTO ³, Miriam ISOLA ⁴, Claudio BATTISTELLA ⁴, Simona GAUDINO ⁵, Enrico PEGOLO ⁶, Silvia CHIESA ⁷, Mauro ARCICASA ⁸, Giuseppe LA ROCCA ², Alessandro OLIVI ², Miran SKRAP ¹, Giovanni SABATINO ^{2, 9}

¹ Unit of Neurosurgery, Department of Neuroscience, Santa Maria della Misericordia University Hospital, Udine, Italy; ² Institute of Neurosurgery, Sacred Heart Catholic University, Rome, Italy; ³ Unit of Neuroradiology, Department of Diagnostic Imaging ASUIUD, Udine, Italy; ⁴ Department of Medicine, Santa Maria della Misericordia University Hospital, Udine, Italy; ⁵ Institute of Radiology, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁶ Institute of Pathology, Santa Maria della Misericordia University Hospital, Udine, Italy; ⁷ Institute of Radiotherapy, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy; ⁸ Department of Radiotherapy, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; ⁹ Department of Neurosurgery, Mater Olbia Hospital, Olbia, Italy

BACKGROUND: Decades of therapeutic and molecular refinements, the prognosis of patients with glioblastoma (GBM) still remains unfavorable. Integrative clinical studies allow a better understanding of the natural evolution of GBM. To assess independent predictors of overall survival (OS) and progression free survival (PFS) clinical, surgical, molecular and radiological variables were evaluated. A novel preoperative volumetric magnetic resonance imaging (MRI) Index for tumor prognosis in GBM patients was investigated.
METHODS: A cohort of 195 cases of patients operated for newly GBM were analyzed. Extent of tumoral resection (EOR), tumor growth pattern, expressed by preoperative volumetric ΔT1-T2 MRI Index, molecular markers such as O6-methylguanine-DNA methyltransferase (MGMT) methylation and isocitrate dehydrogenase 1/2 (IDH1/2) mutation, were analyzed. Analysis of survival was done using Cox-proportional hazard models.
RESULTS: The 1-, 2- years estimated OS and PFS rate for the whole population were 61% and 27%, 38% and 17%, respectively. A better survival rate, both in terms of survival and tumor progression, was observed in patient with higher EOR (P=0.000), younger age (P=0.000), MGMT methylation status (P=0.001) and lower preoperative ΔT1-T2 MRI Index (P=0.004). Regarding the tumor growth pattern a cut-off value of 0.75 was found to discriminate patient with different prognosis. Patients with a preoperative ΔT1-T2 MRI Index <0.75 had a 1-year estimated OS of 67%, otherwise patients with a preoperative ΔT1-T2 MRI Index >0.75 had a 1-year estimated OS of 34%.
CONCLUSIONS: In this investigation longer survival is associated with younger age, EOR, promoter methylation of MGMT and preoperative tumor volumetric features expressed by ΔT1-T2 MRI Index The preoperative ΔT1-T2 MRI Index could be a promising prognostic factor potentially useful in GBM management. Future investigations based on multiparametric MRI data and next generation sequences analysis, may better clarify this result.

KEY WORDS: Glioblastoma; Survival; Prognosis; Magnetic resonance imaging