Serum concentrations of glial fibrillary acidic protein (GFAP) do not indicate tumor recurrence in patients with glioblastoma
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Recent studies identified serum concentrations of the astroglial protein glial fibrillary acidic protein (GFAP) to be indicative of glioblastoma (GBM) in patients with newly diagnosed space occupying cerebral mass lesions. Until now, no data is available whether GFAP serum concentrations decrease after first therapy and whether GFAP may be used as a predictor of survival and an indicator of tumor recurrence. In this prospective study, we included 44 patients with a single space occupying cerebral mass lesion suspicious for GBM. GBM was histopathologically proven in 33 cases. After initial therapy, patients were followed up until tumor recurrence (defined according to the RANO criteria) or death (maximum observation period 78 weeks). Blood was sampled on a regular basis, and GFAP serum levels were determined using an immunofluorescence assay. Prior to any intervention, 14 of the 33 GBM patients had elevated GFAP serum concentrations (median 0.25 µg/L, interquartile range 0.13–0.53), whereas only one out of 11 patients having other tumor entities revealed a slightly increased GFAP serum level (0.06 µg/L). Following surgery (i.e., biopsy, full or partial resection), all initially GFAP positive GBM patients showed decreased serum concentrations. During the follow-up period, we found a minimal GFAP increase in one patient only (0.04 µg/L; week 52), although 23 out of 31 available GBM patients developed tumor progression or died. No difference was found regarding the survival rate and the time to tumor recurrence between initially GFAP positive and GFAP negative GBM patients. In GBM patients, initially elevated GFAP serum concentrations decrease after the first diagnostic or therapeutic intervention. GFAP was not predictive for tumor recurrence.
KeywordsGlioblastoma GFAP Tumor recurrence Biomarker Serum
Central nervous system
Glial fibrillary acidic protein
Fluid attenuated inversion recovery
Isocitrate dehydrogenase 1
Magnet resonance imaging
Primitive neuroectodermal tumor
Response assessment in neuro-oncology
World Health Organization
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Conceived and designed the experiments: JV, JT, CF. Performed the experiments: JV, MW. Analyzed the data: JV, JT, JR, CF. Contributed reagents, materials, financial support: CF. Wrote the paper: JV, JT, JR, CF. Supervisor of the study: CF. Corrected and approved the final version of the manuscript: all authors.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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