Classification of Progression Patterns in Glioblastoma: Analysis of Predictive Factors and Clinical Implications

Haihui Jiang; Kefu Yu; Mingxiao Li; Yong Cui; Xiaohui Ren; Chuanwei Yang; Xuzhe Zhao; Song Lin

doi:10.3389/fonc.2020.590648

Classification of Progression Patterns in Glioblastoma: Analysis of Predictive Factors and Clinical Implications

Front Oncol. 2020 Nov 3:10:590648. doi: 10.3389/fonc.2020.590648. eCollection 2020.

Authors

Haihui Jiang^{1

2}, Kefu Yu³, Mingxiao Li^{1

2}, Yong Cui^{1

2}, Xiaohui Ren^{1

2}, Chuanwei Yang^{1

2}, Xuzhe Zhao^{1

2}, Song Lin^{1

2}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
² National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders and Beijing Key Laboratory of Brain Tumor, Beijing, China.
³ Department of Pharmacy, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.

Abstract

Background: This study was designed to explore the progression patterns of IDH-wildtype glioblastoma (GBM) at first recurrence after chemoradiotherapy.

Methods: Records from 247 patients who underwent progression after diagnosis of IDH-wildtype GBM was retrospectively reviewed. Progression patterns were classified as either local, distant, subependymal or leptomeningeal dissemination based on the preoperative and serial postoperative radiographic images. The clinical and molecular characteristics of different progression patterns were analyzed.

Results: A total of 186 (75.3%) patients had local progression, 15 (6.1%) patients had distant progression, 33 (13.3%) patients had subependymal dissemination, and 13 (5.3%) patients had leptomeningeal dissemination. The most favorable survival occurred in patients with local progression, while no significant difference of survival was found among patients with distant progression, subependymal or leptomeningeal dissemination who were thereby reclassified into non-local group. Multivariable analysis showed that chemotherapy was a protective factor for non-local progression, while gender of male, subventricular zone (SVZ) involvement and O⁶-methylguanine-DNA-methyltransferase (MGMT) promoter methylation were confirmed as risk factors for non-local progression (P < 0.05). Based on the factors screened by multivariable analysis, a nomogram was constructed which conferred high accuracy in predicting non-local progression. Patients in non-local group could be divided into long- and short-term survivors who differed in the rates of SVZ involvement, MGMT promoter methylation and reirradiation (P < 0.05), and a nomogram integrating these factors showed high accuracy in predicting long-term survivors.

Conclusion: Patients harboring different progression patterns conferred distinct clinical and molecular characteristics. Our nomograms could provide theoretical references for physicians to make more personalized and precise treatment decisions.

Keywords: glioblastoma; nomogram; prognosis; progression; subventricular zone.