Assessment of Pre-operative Measurements of Tumor Size by MRI Methods as Survival Predictors in Wild Type IDH Glioblastoma

Abstract

Objective: We evaluate the performance of three MRI methods to determine non-invasively tumor size, as overall survival (OS) and Progression Free Survival (PFS) predictors, in a cohort of wild type, IDH negative, glioblastoma patients. Investigated protocols included bidimensional (2D) diameter measurements, and three-dimensional (3D) estimations by the ellipsoid or semi-automatic segmentation methods. Methods: We investigated OS in a cohort of 44 patients diagnosed with wild type IDH glioblastoma (58.2 ± 11.4 years, 1.9/1 male/female) treated with neurosurgical resection followed by adjuvant chemo and radiotherapy. Pre-operative MRI images were evaluated to determine tumor mass area and volume, gadolinium enhancement volume, necrosis volume, and FLAIR-T 2 hyper-intensity area and volume. We implemented then multivariate Cox statistical analysis to select optimal predictors for OS and PFS. Results: Median OS was 16 months (1–42 months), ranging from 9 ± 2.4 months in patients over 65 years, to 18 ± 1.6 months in younger ones. Patients with tumors carrying O 6 -methylguanin-DNA-methyltransferase (MGMT) methylation survived 30 ± 5.2 vs. 13 ± 2.5 months in non-methylated. Our study evidenced high and positive correlations among the results of the three methods to determine tumor size. FLAIR-T 2 hyper-intensity areas (2D) and volumes (3D) were also similar as determined by the three methods. Cox proportional hazards analysis with the 2D and 3D methods indicated that OS was associated to age ≥ 65 years (HR 2.70, 2.94, and 3.16), MGMT methylation (HR 2.98, 3.07, and 2.90), and FLAIR-T 2 ≥ 2,000 mm 2 or ≥60 cm 3 (HR 4.16, 3.93, and 3.72), respectively. Other variables including necrosis, tumor mass, necrosis/tumor ratio, and FLAIR/tumor ratio were not significantly correlated with OS. Conclusion: Our results reveal a high correlation among measurements of tumor size performed with the three methods. Pre-operative FLAIR-T 2 hyperintensity area and volumes provided, independently of the measurement method, the optimal neuroimaging features predicting OS in primary glioblastoma patients, followed by age ≥ 65 years and MGMT methylation.

Reclassification of Glioblastoma Multiforme According to the 2021 World Health Organization Classification of Central Nervous System Tumors: A Single Institution Report and Practical Significance

“…Regarding the tumor localization, Flores in a cohort of 44 patients, including only cases of GBM according to the WHO classification from 2021 and very close to our demographic characteristics, found that the majority of tumors (59.1%) are located in the right cerebral hemisphere, and the most common localization relative to the lobe is the frontal (29.5%), followed by temporal and parietal with 25%, and the rarest localization in the occipital lobe [ 22 ]. In another study, similar in volume and gender distribution but with a significantly lower mean age (49.05 years), Abd-Elghany found that again the most common site of GBM was in the frontal lobe, followed by the temporal, parietal, occipital lobes, and most rarely-subtentorial [ 23 ].…”

Perioperative red blood cell transfusion is associated with poor functional outcome and overall survival in patients with newly diagnosed glioblastoma

“…Preoperative tumor volumes volumetrically were assessed based on gadolinium-enhanced T1-weighted MRI using commercially available software (TumorTracking Tool, IntelliSpace Portal 5.0, Philips, the Netherlands). In accordance to Flores et al [ 19 ], a cutoff value of 60 mL of tumor volume was chosen in order to analyze for a potential correlation between tumor volume and PBT. Every neurosurgeon in charge fulfilled the requirements for Neuro-Oncology Centers certificated by the German Cancer Society.…”

Prognostic Factors of Survival in Glioblastoma Multiforme Patients—A Retrospective Study

“…Moreover, GBM patients have a meagre immune response by promoting a tumor-induced anti-inflammatory response and creating an immunosuppressive environment for tumor growth [ 1 , 2 ]. Consequently, regardless of how rapidly the diagnosis is determined and how the treatment is initiated, the overall survival is extremely low, i.e., only 12–18 months [ 3 ].…”

“…Regarding GBM prognosis, several markers have been taken into consideration. According to the WHO classification, there are two subtypes of GBM depending on their respective genetic features, particularly, the presence or absence of IDH mutations: primary and secondary GBMs [ 3 , 4 ]. On the one hand, primary GBMs usually occur in elderly patients, have no precursor benign or malignant lesions and generally yield a worse prognosis [ 2 , 4 , 5 ].…”

“…On the one hand, primary GBMs usually occur in elderly patients, have no precursor benign or malignant lesions and generally yield a worse prognosis [ 2 , 4 , 5 ]. On the other hand, secondary GBMs appear at a younger age, typically develop from lower grade gliomas, are associated with IDH mutations, and have a longer overall survival [ 3 ]. Furthermore, it has been demonstrated that different histopathological subtypes respond differently to treatment and, consequently, have distinct survival rates [ 6 ].…”