Clinical features associated with the efficacy of chemotherapy in patients with glioblastoma (GBM): a surveillance, epidemiology, and end results (SEER) analysis

Abstract

Background Glioblastoma (GBM) is a highly malignant brain tumor with poor survival and prognosis. Randomized trials have demonstrated that chemotherapy improves survival in patients with GBM. This study aims to examine the clinical characteristics that are potentially associated with the efficacy of chemotherapy and the risk factors of GBM. Methods A total of 25,698 patients diagnosed with GBM were identified between 2004 and 2015 from the Surveillance, Epidemiology, and End Results (SEER). The clinical and demographic variables between groups were examined by Student’s t-test and Pearson’s chi-square test. GBM-specific survival (GBMSS) and overall survival (OS) were evaluated using the Kaplan-Meier method with the log-rank test. Univariable and multivariable analyses were also performed using the Cox proportional hazards model to identify statistically significant prognostic factors. Results Patients who received chemotherapy had better overall survival (median OS 13 vs. Three months, HR = 1.9224, 95%CI 1.8571–1.9900, p < 0.0001) and better GBMSS (median GBMSS of 12 vs. Three months, HR = 1.9379, 95%CI 1.8632–2.0156, p < 0.0001), compared to patients who did not. Further subgroup analysis revealed that among patients who underwent chemotherapy, those who were younger, with a supratentorial tumor, received surgery, or radiotherapy had both improved OS and GBMSS. Age, race, tumor location, tumor size, and treatments were identified as independent prognostic factors by multivariable analyses for patients with glioblastoma. Conclusion Patients with GBM who were younger (< 65 years), underwent surgery, or radiotherapy can benefit more from chemotherapeutic regimens. Age, race, tumor size, tumor location, surgery, radiotherapy, and chemotherapy were factors associated with the prognosis of patients with GBM.

Valproic Acid Enhanced Temozolomide-Induced Anticancer Activity in Human Glioma Through the p53–PUMA Apoptosis Pathway

“…Younger age (<65 years), seizure history, and longterm VPA treatment (>30 days) were associated with favorable outcomes (Supplementary Figures S1A, C and Figure 1A). The results are roughly concordant with other studies (52,54). On the other hand, the median survival of recurrent GBM patients was 13.10 ± 2.34 months, which was not significantly different from that of newly diagnosed patients (p = 0.300).…”

“…In this study, our results indicate that VPA enhances TMZ cytotoxicity by promoting apoptosis through enhancing p53 pathway activation and increasing the expression of its (50)(51)(52). Several known prognostic factors include age, preoperative functional status, history of seizure, tumor location and size, extent of surgery, use of radiotherapy, and IDH mutation (52)(53)(54)(55)(56). In our study, the median survival of newly diagnosed GBM patients was 15.67 ± 1.42 months.…”

“…Whether p53 mutation affects GBM sensitivity to chemotherapy and prognosis remains controversial (46)(47)(48)(49). In this study, our results indicate that VPA enhances TMZ cytotoxicity by promoting apoptosis through enhancing p53 pathway activation and increasing the expression of its (50)(51)(52). Several known prognostic factors include age, preoperative functional status, history of seizure, tumor location and size, extent of surgery, use of radiotherapy, and IDH mutation (52)(53)(54)(55)(56).…”

Advanced Imaging Techniques for Newly Diagnosed and Recurrent Gliomas

“…In an effort to distinguish tumor progression and pseudoprogression on imaging, the updated Response Assessment in Neuro-Oncology (RANO) criteria were developed in 2010. The RANO criteria state that tumor progression taking place during the 12 week period following the completion of radiotherapy can only be identified through imaging if new tumor enhancement arises outside of the radiation field ( Wen et al, 2021 ). Clues to true progression cited in other articles include increased T2/FLAIR signal extending past the radiation field as well as involvement of the corpus callosum, signal that crosses midline, and subependymal involvement ( Mullins et al, 2005 ; Abel et al, 2012 ; Strauss et al, 2019 ).…”

Parvifloron D-based potential therapy for glioblastoma: Inducing apoptosis via the mitochondria dependent pathway

“…In spite of the efforts made to increase patient survival, GB still has low survival rates (∼15–18 months after diagnosis), which is mainly attributed to the late diagnosis of this tumor ( Alifieris and Trafalis, 2015 ; Wick et al, 2018 ; Wen et al, 2021 ). Surgical resection followed by concomitant chemoradiotherapy and adjuvant chemotherapy (temozolomide (TMZ)) is the standard of care for GB patients ( Alifieris and Trafalis, 2015 ; Wick et al, 2018 ; Le Rhun et al, 2019 ; Wen et al, 2021 ).…”