The effect of GBM molecular division and maximum excision of fortified or non-enhanced lesions on patient prognosis

The molecular division of glioblastoma (GBM) is instructive in evaluating its prognosis.
such as 1.2 years of total survival (OS) in 91% of IDH-wt patients and 3.6 years in 9% of IDH-mutant (IDH-mut) patients.
the maximum removal of MRI-T1 weighted enhanced image reinforcement (CE) lesions was positively related to patient lifetime extension.
, however, it is not clear how the maximum removal of CE lesions affects the prognosis of patients with GBM in different molecular groups, and the significance of removing non-enhanced (NCE) lesions.
M. Molinaro of neurosurgery at the University of California, San Francisco, USA, and others studied the relationship between GBM molecular division and CE and NCE lesions removal and patient prognosis, the results were published online February 2020 in JAMA Oncol.
Research Methodology The multi-center retrospective queue study included 761 GBM patients at the University of California, San Francisco, with a middle follow-up of 9.6 years between January 1, 1997 and December 31, 2017.
also selected 107 GBM patients from the Mayo Clinic with a medium follow-up of 5.7 years between 1 January 2004 and 31 December 2014 and 99 GBM patients from the Cleveland Clinic with a medium follow-up of 10.9 months between 1 January 2008 and 31 December 2011 as a validation group.
of the 761 newly diagnosed GBM patients in the study group, 468 were male (61.5%) and 293 (38.5%), and the middle age was 60 years (IQR, 51.6-67.7 years).
IDH was detected in 514 patients, of which 478 (93.0%) were IDH-wt.
MGMT was detected in 205 patients, of which 94 (45.9%) were MGMT methylation.
patients with IDH-wt, the proportion of MGMT methylation was lower (45%), while in patients with IDH-mut, the proportion of MGMT methylation was higher (60%).
87%-100% of patients with CE lesions, with a medium of 97%.
39%-70% of patients with NCE lesions, with a median of 54%.
514 patients tested for IDH, the CE lesions of IDH-wt were similar to those of IDH-mut (89.9%: 89.5% ;P -0.90).
as of December 10, 2018, the medium follow-up time was 9.6 years (95% CI, 7.7-13.4) and the mid-OS was 14.2 months (95% CI, 13.3-15.2).
patients with IDH-wt, CE (HR=0.95;95% CI, 0.91-0.99; P=0.02) and NCE (HR=0.96; 95% CI, 0.93-0.99; P=0.02) were positively related to pre-expected excision.
MGMT status does not affect the relationship between CE and NCE lesions and prognosis in IDH-wt patients.
the researchers divided 434 patients diagnosed with GBM after 2005 and who had tested positive for IDH into four groups for analysis.
38 cases in a group of 1 with no treatment with the worst prognosmence, with a medium OS of 3.6 months (95% CI, 2.6-5.4).
2 groups of 122 patients, aged >65 years old, who received the treatment of thymosamine, had a better prognostication than 1 group, with a medium OS of 12.4 months (95% CI, 11.4-14.0).
3 groups of 212 patients, age ≤65 years old, postoperative residual NCE lesions>5.4mL, IDH-wt patients treated with thymosamine, the prognosis was better than 2 groups, the middle OS was 16.5 months (95% CI, 14.7-18.3).
4 groups received the best prognosis, can be divided into two subgroups: 4A group 28 IDH-mut patients, 4B group 34 IDH-wt patients, age ≤65 years old, CE lesions removal rate median 100%, NCE lesions are 90% median, postoperative residual NCE lesions ≤5.4mL, median OS is 37.3 months (95% CI, 31.6-70.7).
the first 3 years of treatment, IDH-wt young patients with fully removed lesions (group 4A) had a prognosis similar to that of IDH-mut patients (group 4B).
years, the survival rate of IDH-wt patients decreased significantly compared to that of IDH-mut patients.
two validation groups confirmed the results.
the correlation between tumor removal and prognosis in IDH-wt patients, without considering the age of diagnosis.
1 group of 25 patients with preoperative NCE lesions >73.8mL, with a medium OS of 4.2 months (95% CI, 3.3-4.9).
200 cases in 2 groups, without treatment with thymosamine, preoperative NCE lesions ≤73.8mL patients>≤ In patients with a rate of CE lesions ≤77%, the prognosis was better than that of group 1, with a medium OS of 11.6 months (95% CI, 10.6-13.2).
3 groups of 217 cases, age ≤65 years old, treated with tymoamine, CE lesions excision rate >77%, postoperative residual NCE lesions >5.4mL patients, the prognosis was better than 2 groups, the middle OS was 17.9 months (95% CI, 16.4-19.7).
4 group of 36 cases, aged ≤65 years old, received the treatment of timoazamine, CE lesions excision rate >77%, postoperative residual NCE lesions ≤5.4mL patients, the prognosis was better than 3 groups, the middle OS was 31.7 months (95% CI, 22.2-56.2).
Conclusion The study evaluated for the first time the degree of GBM strengthening and non-enhanced lesions removal, tumor molecular division and clinical information≤, and found that the maximum excision of CE lesions in patients with different molecular groups of newly diagnosed GBM was positively related to OS;
for elderly patients, regardless of molecular type, the maximum removal of fortified lesions can improve the overall survival rate.
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