Epidemiologic Features, Survival, and Prognostic Factors Among Patients With Different Histologic Variants of Glioblastoma: Analysis of a Nationwide Database

Li-Tsun Shieh; Chung-Han Ho; How-Ran Guo; Chien-Cheng Huang; Yi-Chia Ho; Sheng-Yow Ho

doi:10.3389/fneur.2021.659921

Epidemiologic Features, Survival, and Prognostic Factors Among Patients With Different Histologic Variants of Glioblastoma: Analysis of a Nationwide Database

Front Neurol. 2021 Nov 24:12:659921. doi: 10.3389/fneur.2021.659921. eCollection 2021.

Authors

Li-Tsun Shieh¹, Chung-Han Ho^{2

3}, How-Ran Guo^{4

5}, Chien-Cheng Huang^{2

6}, Yi-Chia Ho⁷, Sheng-Yow Ho^{1

8

9}

Affiliations

¹ Department of Radiation Oncology, Chi Mei Medical Center, Liouying, Liouying, Tainan, Taiwan.
² Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
³ Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
⁴ Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
⁵ Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
⁶ Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan.
⁷ Departement of Medical Education, Chi Mei Medical Center, Tainan, Taiwan.
⁸ Department of Radiation Oncology, Chi Mei Medical Center, Tainan, Taiwan.
⁹ Graduate Institute of Medical Science, Chang Jung Christian University, Tainan, Taiwan.

Abstract

Background: Glioblastoma (GBM) is the most common primary intracranial malignancy. Previous studies found incidence of GBM varies substantially by age, sex, race and ethnicity, and survival also varies by country, ethnicity, and treatment. Gliosarcoma (GSM) and giant cell glioblastoma (GC-GBM) are different histologic variants of GBM with distinct clinico-pathologic entities. We conducted a study to compare epidemiology, survival, and prognostic factors among the three. Methods: We identified GBM patients diagnosed between 2000 and 2016 using the Taiwan Cancer Registry and followed them using the death registry. Survival was compared among conventional GBM and two histologic variants. The potential confounding factors evaluated in this study included registered year, age, sex, and treatment modality (resection, radiotherapy, and chemotherapy). Results: We enrolled 3,895 patients, including 3,732 (95.8%) with conventional GBM, 102 (2.6%) with GSM, and 61 (1.6%) with GC-GBM. GC-GBM patients had younger mean age at diagnosis (49.5 years) than conventional GBM patients (58.7 years) and GSM patients (61.3 years) (p < 0.01). The three groups had similar sex distributions (p = 0.29). GC-GBM had a longer median survival [18.5, 95% confidence interval (CI): 15.8-25.3 months] than conventional GBM (12.5, 95%CI: 12.0-13.0 months) and GSM (12.8, 95%CI: 9.2-16.2 months), and the differences in overall survival did not attain statistical significance (p = 0.08, log-rank test). In univariate analysis, GC-GBM had better survival than conventional GBM, but the hazard ratio (0.91) did not reach statistical significance (95%CI: 0.69-1.20) in the multivariate analysis. Young ages (≤ 40 years), female sex, resection, radiotherapy, and chemotherapy were factors associated with better survival in overall GBMs. In subtype analyses, these factors remained statistically significant for conventional GBM, as well as radiotherapy for GSM. Conclusion: Our analysis found conventional GBM and its variants shared similar poor survival. Factors with age ≤ 40 years, female sex, resection, radiotherapy, and chemotherapy were associated with better prognosis in conventional GBM patients.

Keywords: epidemiology; giant cell glioblastoma; glioblastoma; gliosarcoma; histologic variant.