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. 2025 Sep;174(3):753-764.
doi: 10.1007/s11060-025-05080-3. Epub 2025 May 23.

Survival prediction in glioblastoma: 10-year follow-up from the Dutch Neurosurgery Quality Registry

Jeroen T J M van Dijck  1   2 , Hilko Ardon  3 , Rutger K Balvers  4 , Eelke M Bos  4 , Lisette Bosscher  5 , H Bart Brouwers  3 , Vincent K Y Ho  6 , Koos Hovinga  7 , Lesley Kwee  8 , Mark Ter Laan  9 , Rob J A Nabuurs  1 , Pierre A J T Robe  10 , Sarita van Geest  11 , Olivier van der Veer  12 , Niels Verburg  13 , Michiel Wagemakers  14 , Philip C de Witt Hamer  13 , Mar Rodriguez Girondo  15 , Rishi D S Nandoe Tewarie  16   17 ; Quality Registry Neuro Surgery glioblastoma working group from the Dutch Society of Neurosurgery
Affiliations

Survival prediction in glioblastoma: 10-year follow-up from the Dutch Neurosurgery Quality Registry

Jeroen T J M van Dijck et al. J Neurooncol. 2025 Sep.

Abstract

Purpose: Glioblastoma is the most common and treatment-resistant primary malignant brain tumor, with high morbidity and mortality despite standard treatment protocols. This study aims to evaluate survival and prognostic factors, and introduce two pragmatic prognostic models to inform individualized, patient-centered decision-making, using a large Dutch registry.

Methods: We analyzed a prospective cohort of 7621 patients (2012-2022) in 12 Dutch centers via the Dutch Quality Registry Neurosurgery. Univariate analysis of prognostic factors, Kaplan-Meier survival curves, and funnel plots comparing center performance (30-day and 2-year mortality) were conducted. Two prognostic models using multivariate Cox regression were developed.

Results: Glioblastoma incidence was 3.9/100.000 in The Netherlands. Overall, 30-day mortality was 5.1% and 2-year survival 17.8%. Overall median survival was 10.4 months, with 4.6 months after biopsy and 12.9 months post-resection. Poorer survival correlated with older age, higher ASA classification, lower Karnofsky Performance Status, biopsy over resection (HR 0.49, 95% CI 0.47-0.52), and postoperative complications (HR 1.57 95% CI 1.39-1.79). MGMT promotor methylation (HR 0.58, 95% CI 0.53-0.63) and adjuvant treatment were linked to lower mortality. Treatment variation and outcomes were within expected ranges; surgical volume did not affect survival. The prognostic models had C-indices of 0.704 (6-month) and 0.721 (2-year).

Conclusion: Surgical resection and adjuvant therapy improved survival, but prognosis remained poor. Age, premorbid condition, treatment and molecular markers influenced survival. Center variations were within expected range, and higher surgical volume did not improve outcomes. The developed prognostic models could potentially inform clinicians, pending external validation.

Keywords: Glioblastoma; Patient outcome; Prognostic model; Survival.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no conflict of interest Ethical approval: The study was performed in line with the principles of the Declaration of Helsinki. Ethical approval was not necessary because the study is not subject to the Medical Research Involving Human Subjects Act.

Figures

Fig. 1
Fig. 1
Hazard ratios (HR) for death from univariate Cox analysis
Fig. 2
Fig. 2
Among center differences in 30-day mortality and 2-year survival. The x-axis represents the center’s sample size, and the funnel shape was created by control limits at the 95% and 99% confidence levels. Yellow squares are small volume centers (< 50 operated cases annually)
Fig. 3
Fig. 3
Chart of predicted survival in months according to prognostic model 1 involving type of surgery, preoperative KPS, ASA and age
See this image and copyright information in PMC

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