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. 2023 Aug 30:10:1249366.
doi: 10.3389/fsurg.2023.1249366. eCollection 2023.

What predicts survival in glioblastoma? A population-based study of changes in clinical management and outcome

B Fekete  1   2 , K Werlenius  2   3 , M Tisell  1   4 , A Pivodic  1 , A Smits  1   5 , A S Jakola  1   4 , B Rydenhag  1   4
Affiliations

What predicts survival in glioblastoma? A population-based study of changes in clinical management and outcome

B Fekete et al. Front Surg. .

Abstract

Background: Glioblastoma is the most common and most aggressive primary brain tumor in adults. Despite multimodal treatment, the median survival time is 15-16 months and 5-year survival rate 5%-10%. The primary goal of this study was to identify prognostic factors for survival in an unselected population of patients operated for glioblastoma. The secondary goal was to explore changes in outcome and the clinical management of this patient group over time.

Methods: We identified 222 consecutive adults operated for glioblastoma between November 2012 and June 2016 at the Department of Neurosurgery, Sahlgrenska University Hospital in Gothenburg, serving a health care region in the western part of Sweden with 1.900.000 inhabitants. Clinical variables were identified and tested as predictors for prognosis in extended Poisson regression models. The results were compared with a previously published cohort from 2004 to 2008, before current standard of care based on molecular tumor diagnosis was fully implemented.

Results: Median overall survival was 1.07 years, which was significantly longer than in the 2004-2008 cohort (1.07 vs. 0.73 y, age- and sex adjusted HR = 1.89, p < 0.0001). Variables associated with longer survival in the multivariable model were MGMT promoter hypermethylation, non-central tumor location, complete resection of enhancing tumor, WHO performance status 0-1, unilateral tumor location, fewer lobes involved, younger age and no comorbidities.

Conclusion: The median survival for patients with glioblastoma treated according to current standard treatment has moderately but significantly increased, with MGMT promoter hypermethylation as the strongest predictor for survival.

Keywords: glioblastoma; population-based; prognostic factors; survival; treatment.

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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
Flow chart of patient selection.
Figure 2
Figure 2
(A) The overall survival probability obtained by poisson regression for time-varying data and Kaplan–Meier technique. (B) Survival probability for the different groups of patients. CRET, complete resection of enhancing tumor; MGMT, 6O-methylguanine-DNA methyltransferase; RCT and adj TMZ, postoperative radiochemotherapy and adjuvant temozolomide; +MGMT, methylated MGMT promoter; –MGMT, unmethylated MGMT promoter.
Figure 3
Figure 3
Median OS in relation to (A) age, (B) surgical treatment and (C) post-operative oncological treatment.
See this image and copyright information in PMC

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