Validation of postoperative residual contrast-enhancing tumor volume as an independent prognostic factor for overall survival in newly diagnosed glioblastoma
Validation of postoperative residual contrast-enhancing tumor volume as an independent prognostic factor for overall survival in newly diagnosed glioblastoma
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DOI：
10.1093/neuonc/noy053
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发表时间：
2018-09-01
期刊：
影响因子：
15.9
通讯作者：
Cloughesy, Timothy F.
中科院分区：
文献类型：
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作者：
Ellingson, Benjamin M.;Abrey, Lauren E.;Cloughesy, Timothy F.
背景在本研究中，我们汇总了来自国际多中心临床试验、单机构数据库和多中心临床试验联盟的新诊断胶质母细胞瘤（GBM）患者的影像学数据，以确定术后残留增强肿瘤体积与总生存期（OS）之间的关系。来自5个数据源的1511例新诊断GBM患者的数据纳入本研究：（i）来自UCLA的单一机构数据库（N = 398;发现）;（ii）来自Ben and Cathy Ivy早期临床试验基金会网络放射基因组学数据库的患者（N = 262，来自8个中心;确认）;（iii）来自国际III期试验的放化疗安慰剂组（AVAglio; N = 394，来自23个国家的120个地点;验证）;（iv）来自AVAglio的实验组检查放化疗加贝伐单抗（N = 404，来自23个国家的120个地点;探索性集1）;和（v）Alliance（N 0874）伏立诺他加放化疗的I/II期试验（N = 53;探索性集2）。使用T1减影图对术后残留增强病变进行定量。采用多变量考克斯回归模型分析临床变量、O-6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）状态和残留肿瘤体积对OS的影响。在接受标准化放疗的新诊断GBM中，观察到术后残留增强肿瘤体积与OS之间存在对数线性关系。术后肿瘤体积是OS的预后因素（P < 0.01），与治疗、年龄和MGMT启动子甲基化状态无关。术后残留的造影剂增强疾病对接受放化疗联合或不联合实验性治疗的新诊断GBM患者的生存率有显著的负面影响。
Background. In the current study, we pooled imaging data in newly diagnosed glioblastoma (GBM) patients from international multicenter clinical trials, single institution databases, and multicenter clinical trial consortiums to identify the relationship between postoperative residual enhancing tumor volume and overall survival (OS).Methods. Data from 1511 newly diagnosed GBM patients from 5 data sources were included in the current study: (i) a single institution database from UCLA (N = 398; Discovery); (ii) patients from the Ben and Cathy Ivy Foundation for Early Phase Clinical Trials Network Radiogenomics Database (N = 262 from 8 centers; Confirmation); (iii) the chemoradiation placebo arm from an international phase III trial (AVAglio; N = 394 from 120 locations in 23 countries; Validation); (iv) the experimental arm from AVAglio examining chemoradiation plus bevacizumab (N = 404 from 120 locations in 23 countries; Exploratory Set 1); and (v) an Alliance (N0874) phase I/II trial of vorinostat plus chemoradiation (N = 53; Exploratory Set 2). Postsurgical, residual enhancing disease was quantified using T1 subtraction maps. Multivariate Cox regression models were used to determine influence of clinical variables, O-6-methylguanine-DNA methyltransferase (MGMT) status, and residual tumor volume on OS.Results. A log-linear relationship was observed between postoperative, residual enhancing tumor volume and OS in newly diagnosed GBM treated with standard chemoradiation. Postoperative tumor volume is a prognostic factor for OS (P < 0.01), regardless of therapy, age, and MGMT promoter methylation status.Conclusion. Postsurgical, residual contrast-enhancing disease significantly negatively influences survival in patients with newly diagnosed GBM treated with chemoradiation with or without concomitant experimental therapy.