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Multi-center study finds postoperative residual non-enhancing component of glioblastoma as a new determinant of patient outcome

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Abstract

Introduction

The aim of the present study is to assess whether postoperative residual non-enhancing volume (PRNV) is correlated and predictive of overall survival (OS) in glioblastoma (GBM) patients.

Methods

We retrospectively analyzed a total 134 GBM patients obtained from The University of Texas MD Anderson Cancer Center (training cohort, n = 97) and The Cancer Genome Atlas (validation cohort, n = 37). All patients had undergone postoperative magnetic resonance imaging immediately after surgery. We evaluated the survival outcomes with regard to PRNV. The role of possible prognostic factors that may affect survival after resection, including age, sex, preoperative Karnofsky performance status, postoperative nodular enhancement, surgically induced enhancement, and postoperative necrosis, was investigated using univariate and multivariate Cox proportional hazards regression analyses. Additionally, a recursive partitioning analysis (RPA) was used to identify prognostic groups.

Results

Our analyses revealed that a high PRNV (HR 1.051; p-corrected = 0.046) and old age (HR 1.031; p-corrected = 0.006) were independent predictors of overall survival. This trend was also observed in the validation cohort (higher PRNV: HR 1.127, p-corrected  = 0.002; older age: HR 1.034, p-corrected  = 0.022). RPA analysis identified two prognostic risk groups: low-risk group (PRNV < 70.2 cm3; n = 55) and high-risk group (PRNV ≥ 70.2 cm3; n = 42). GBM patients with low PRNV had a significant survival benefit (5.6 months; p = 0.0037).

Conclusion

Our results demonstrate that high PRNV is associated with poor OS. Such results could be of great importance in a clinical setting, particularly in the postoperative management and monitoring of therapy.

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Acknowledgements

We thank The Cancer Genome Atlas and The Cancer Imaging Archive initiatives for making the clinical and imaging data publicly available. This research was partially funded by the John S. Dunn Sr. Distinguished Chair in Diagnostic Imaging Fund, MD Anderson Brain Tumor Center Program, MD Anderson Cancer Center startup funding, and the Cancer Prevention and Research Institute of Texas Individual Investigator Research Award (RP160150).

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Aikaterini Kotrotsou, Ahmed Elakkad, Ginu A. Thomas, Srishti Abrol, Ali S. Bakhtiari, Markus M. Luedi, Ashok J. Kumar & Rivka R. Colen

  2. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jia Sun & Wei Wei

  3. Department of Diagnostic Interventional and Imaging, The University of Texas Health Science Center, Houston, TX, USA

    Dongni Yang

  4. Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Jeffrey S. Weinberg, Raymond Sawaya & Pascal O. Zinn

  5. Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Moritz F. Kircher

  6. Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    John F. de Groot

  7. Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA

    Pascal O. Zinn

  8. Department of Cancer Systems Imaging, The University of Texas MD Anderson Cancer Center, 1881 East Road, Houston, 77054, TX, USA

    Aikaterini Kotrotsou & Rivka R. Colen

  9. Department of Anesthesiology, Bern University Hospital Inselspital, University of Bern, Bern, Switzerland

    Markus M. Luedi

  10. Department of Cancer Biology, Division of Basic Science Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Pascal O. Zinn

Authors
  1. Aikaterini Kotrotsou
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  2. Ahmed Elakkad
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  4. Ginu A. Thomas
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  7. Wei Wei
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  8. Jeffrey S. Weinberg
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  9. Ali S. Bakhtiari
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  12. John F. de Groot
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  13. Raymond Sawaya
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  14. Ashok J. Kumar
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  16. Rivka R. Colen
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Correspondence to Rivka R. Colen.

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Kotrotsou, A., Elakkad, A., Sun, J. et al. Multi-center study finds postoperative residual non-enhancing component of glioblastoma as a new determinant of patient outcome. J Neurooncol 139, 125–133 (2018). https://doi.org/10.1007/s11060-018-2850-4

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  • DOI: https://doi.org/10.1007/s11060-018-2850-4

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