Artikel
Long-term survivors of glioblastoma – which factors influence survival in those who have crossed the three-year mark?
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Autoren
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Alexandra Sachkova
- The Translational Neurooncology Research Group, , Department of Neurosurgery, , Georg-August University Göttingen, , Göttingen, Deutschland
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Maria Goldberg
- I.M. Sechenov First Moscow State Medical University, Burdenko Neurosurgical Institute, Moscow, Russian Federation
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Sergey Goraynov
- Burdenko Neurosurgical Institute, Moscow, Russian Federation
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Alexander Potapov
- Burdenko Neurosurgical Institute, Moscow, Russian Federation
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Veit Rohde
- Universitätsmedizin Göttingen, Klinik und Poliklinik für Neurochirurgie, Göttingen, Deutschland
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Liudmila Shishkina
- Burdenko Neurosurgical Institute, Moscow, Russian Federation
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Hans Christoph Bock
- Schwerpunkt Kinderneurochirurgie, Neurochirurgische Klinik, Universitätsmedizin Göttingen UMG, Göttingen, Deutschland
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Bawarjan Schatlo
- Universitätsklinik Göttingen, Klinik f. Neurochirurgie, Göttingen, Deutschland
| Veröffentlicht: | 9. Juni 2017 |
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Gliederung
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Objective: Long time survivors (LTS) of glioblastoma (GBM) are defined as patients surviving longer than 36 months. It is known that LTS are set apart from other patients by a combination of 1) positive clinical and 2) molecular factors such as IDH1 and MGMT. We herein present data from a large cohort of LTS based on a collaborative database of two large oncology centers. This large database enabled us to identify characteristics of prognostic relevance within the group of LTS.
Methods: Patients treated for GBM between 1998 and 2012 were included in this study. We extracted records of patients surviving > 36 months after first diagnosis. We evaluated patient-related (age, sex, KPS), surgical (extent of resection, number of surgeries), treatment-related parameters and molecular markers (IDH1 mutation, MGMT methylation). Progression was defined according to RANO criteria. P-values below 0.05 were considered significant.
Results: We identified 125 LTS (63 female, 50.4%) with a mean overall survival (OS) of 55.7 months (CI 95%=50.7; 60.8) and a PFS of 34.5 months (CI 95%= 28.7; 40.4). 32% of patients survived 4 years after initial diagnosis, while 26.4% survived 3 years and 22.4% survived 5 years. The use of alkylating agents as first line therapy was associated with higher survival (94.3 months (CI 95%=42.2; 146.4) vs. 48.8 months (CI 95%=44.3; 53.3; p<0.001). Patients who underwent multiple surgeries did not have better survival (56.2 months (CI 95%=44.5; 67.8)) than those with single surgery (49.6 months (CI 95%=43.9; 55.2; p>0.05). Additional treatment regimen (subgroups of chemotherapy) for recurrent GBM did not result in differences in outcome (data not shown). A limited number of IDH-1 and MGMT status data was available. Within this smaller sample, patients with IDH-1 mutation (N=14/49, 28.6%, p=0.53) or MGMT promoter methylation (N=10/14, 71.4%, p=0.89) did not have different in progression-free survival and OS compared to their negative counterparts.
Conclusion: In this cohort of LTS, the use of alkylating agents appeared to be associated with longer survival. IDH-1 mutation and MGMT promoter methylation are known to positively affect outcome. However, once patients have passed into the LTS category, these prognostic markers potentially only play a secondary role. Our data prompts the need to identify further prognostic markers in LTS.
