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. 2021 Feb 25:11:597587.
doi: 10.3389/fonc.2021.597587. eCollection 2021.

A Prognostic Model for Glioblastoma Patients Treated With Standard Therapy Based on a Prospective Cohort of Consecutive Non-Selected Patients From a Single Institution

Armita Armina Abedi  1   2 , Kirsten Grunnet  1   2 , Ib Jarle Christensen  3 , Signe Regner Michaelsen  1   4 , Aida Muhic  2 , Søren Møller  1   2 , Benedikte Hasselbalch  1   2 , Hans Skovgaard Poulsen  1   2 , Thomas Urup  1   2
Affiliations

A Prognostic Model for Glioblastoma Patients Treated With Standard Therapy Based on a Prospective Cohort of Consecutive Non-Selected Patients From a Single Institution

Armita Armina Abedi et al. Front Oncol. .

Abstract

Background: Glioblastoma patients administered standard therapies, comprising maximal surgical resection, radiation therapy with concomitant and adjuvant temozolomide, have a variable prognosis with a median overall survival of 15-16 months and a 2-year overall survival of 30%. The aim of this study was to develop a prognostic nomogram for overall survival for glioblastoma patients treated with standard therapy outside clinical trials.

Methods: The study included 680 consecutive, non-selected glioblastoma patients administered standard therapy as primary treatment between the years 2005 and 2016 at Rigshospitalet, Copenhagen, Denmark. The prognostic model was generated employing multivariate Cox regression analysis modeling overall survival.

Results: The following poor prognostic factors were included in the final prognostic model for overall survival: Age (10-year increase: HR = 1.18, 95% CI: 1.08-1.28, p < 0.001), ECOG performance status (PS) 1 vs. 0 (HR = 1.30, 95% CI: 1.07-1.57, p = 0.007), PS 2 vs. 0 (HR = 2.99, 95% CI: 1.99-4.50, p < 0.001), corticosteroid use (HR = 1.42, 95% CI: 1.18-1.70, p < 0.001), multifocal disease (HR = 1.63, 95% CI: 1.25-2.13, p < 0.001), biopsy vs. resection (HR = 1.35, 95% CI: 1.04-1.72, p = 0.02), un-methylated promoter of the MGMT (O6-methylguanine-DNA methyltransferase) gene (HR = 1.71, 95% CI: 1.42-2.04, p < 0.001). The model was validated internally and had a concordance index of 0.65.

Conclusion: A nomogram for overall survival was established. This model can be used for risk stratification and treatment planning, as well as improve enrollment criteria for clinical trials.

Keywords: MGMT = O6-DNA-methylguanine methyltransferase; biomarkers; glioblastoma; glioma grade IV; nomogram; overall survival; prognostic factors; progression-free survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A, B) Kaplan-Meier plots of progression-free survival (PFS) and overall survival (OS) for patients grouped according to year of diagnosis (2-year interval). Median PFS and OS are shown for the total cohort.
Figure 2
Figure 2
Survival of five prognostic groups, illustrated by the estimated survival curves based on combinations of the six independent prognostic factors included in the final model for overall survival. For all illustrated prognostic groups, defined in the table, the age is 65 years, and all have had undergone resection.
See this image and copyright information in PMC

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