Improved Survival with Decreased Wait Time to Surgery in Glioblastoma Patients Presenting with Seizure

Flanigan, Patrick M.; Jahangiri, Arman; Kuang, Ruby; Truong, Albert; Choi, Sarah; Chou, Alvin; Rick, Jonathan W.; Chang, Susan M.; McDermott, Michael W.; Berger, Mitchel S.; Aghi, Manish K.

doi:10.1093/neuros/nyx084

Cited by 36 publications

(28 citation statements)

References 20 publications

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“…Younger age and better KPS are well-known important positive prognostic factors for GBMs in literature. 2 – 5 , 13 ) In the present study only age below 65 years was a significant prognostic factor for longer OS both in uni and multivariate analysis. Pre-operative KPS was associated with better OS only at univariate Cox regression.…”

Section: Discussionsupporting

confidence: 46%

“…In this scenario, Flanigan et al 5) recently published a retrospective series of 443 patients with pre-operative rate of seizure of 28% in which multivariate analysis revealed pre-operative epilepsy to be independently associated with increased survival. However, the same authors reported that, in case of longer delay between time of epilepsy at clinical onset and surgery, the prognostic benefit of pre-operative seizure does not seem significant.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Factors in Glioblastoma: Is There a Role for Epilepsy?

Dobran

Nasi

Chiriatti

et al. 2018

Neurol. Med. Chir.(Tokyo)

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The prognostic relevance of epilepsy at glioblastoma (GBMs) onset is still under debate. In this study, we analyzed the value of epilepsy and other prognostic factors on GBMs survival. We retrospectively analyzed the clinical, radiological, surgical and histological data in 139 GBMs. Seizures were the presenting symptoms in 50 patients out of 139 (35.9%). 123 patients (88%) were treated with craniotomy and tumor resection while 16 (12%) with biopsy. The median overall survival was 9.9 months from surgery. At univariable Cox regression, the factors that significantly improved survival were age less than 65 years (P = 0.0015), focal without impairment of consciousness seizures at presentation (P = 0.043), complete surgical resection (P < 0.001), pre-operative Karnofsky performance status (KPS) > 70 (P = 0.015), frontal location (P < 0.001), radiotherapy (XRT) plus concomitant and adjuvant TMZ (P < 0.001). A multivariable Cox regression showed that the complete surgical resection (P < 0.0001), age less than 65 years (P = 0.008), frontal location (P = 0.0001) and XRT adjuvant temozolomide (TMZ) (P < 0.0001) were independent factors on longer survival. In our series epilepsy at presentation is not an independent prognostic factor for longer survival in GBM patients. Only in the subgroup of patients with focal seizures without impairment of consciousness, epilepsy was associated with an increased significant overall survival at univariate analysis (P = 0.043). Main independent factors for relatively favorable GBMs outcome are complete tumor resection plus combined XRT-TMZ, frontal location and patient age below 65 years old.

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Section: Discussionsupporting

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Prognostic Factors in Glioblastoma: Is There a Role for Epilepsy?

Dobran

Nasi

Chiriatti

et al. 2018

Neurol. Med. Chir.(Tokyo)

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“…Although they reduce the patient quality of life, seizures as a symptom are positively correlated to longer survival in glioblastoma patients [60][61][62]. However, in cases where there is a longer delay between epileptic seizures as a symptom and surgical resection of tumor, this correlation does not seem to be significant [62,63].…”

Section: Long-term Glioblastoma Survivorsmentioning

confidence: 99%

Genetic secrets of long-term glioblastoma survivors

Jovčevska

2018

Bosn J of Basic Med Sci

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Glioblastomas account for the majority of primary brain tumors. Although glioblastomas are considered as rare diseases, they represent 60%-70% of all gliomas and in most cases have fatal consequences. Genetic analyses show great heterogeneity both intratumor and intertumor. This notion opens up debates about glioblastoma origin. Different brain cells including astrocytes, neural stem cells, oligodendrocyte precursor cells and glioblastoma stem cells are proposed as capable of initiation and reseeding a tumor; however data is still inconclusive. Due to high mortality rate, long term glioblastoma survivors are defined as patients who live longer than 2 years post diagnosis. Extreme survivors, living 10 years or more after diagnosis, comprise less than 1% of all patients. Molecular testing suggests differences in the genetic profiles of glioblastoma between short and long term survivors. The most informative indicators are IDH mutations and MGMT promotor methylation. Other genes like FBLN4, EMP3, IGFBP-2, IGFBP-3, LGALS3, MAOB, PDPN, SERPING1 and TIMP1 have also been associated with glioblastoma prolonged survival. Emerging evidence proposes roles of different microRNAs in predicting patient survival. Moreover, clinical features like seizures as a symptom at presentation, age at diagnosis, and the extent of the surgical resection are also factors that influence the length of survival. Because of the small number of long term survivors, it is difficult to examine these samples and draw conclusions about the genetics of glioblastoma longevity. To aid in the clinical care, a thorough "omics" approach is necessary for identifying differences between short and long term glioblastoma survivors.

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“…Several previous reports have addressed the association between SAO occurrence and glioblastoma survival, both with positive 2 , 4–8 and negative 9–17 results. The majority of recent studies has specifically focused on the role of antiepileptic drugs (AED) on the survival effect of SAO.…”

mentioning

confidence: 99%

Preoperative and early postoperative seizures in patients with glioblastoma—two sides of the same coin?

Ahmadipour

Rauschenbach

Santos

et al. 2020

Neuro-Oncology Advances

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Background Symptomatic epilepsy is a common symptom of glioblastoma, which may occur in different stages of disease. There are discrepant reports on association between early seizures and glioblastoma survival, even less is known about the background of these seizures. We aimed at analyzing the risk factors and clinical impact of perioperative seizures in glioblastoma. Methods All consecutive cases with de-novo glioblastoma treated at our institution between 01/2006 and 12/2018 were eligible for this study. Perioperative seizures were stratified into seizures at onset (SAO) and early postoperative seizures (EPS, ≤21days after surgery). Associations between patients characteristics and overall survival (OS) with SAO and EPS were addressed. Results In the final cohort (n=867), SAO and EPS occurred in 236 (27.2%) and 67 (7.7%) patients respectively. SAO were independently predicted by younger age (p=0.009), higher Karnofsky Performance Scale score (p=0.002), tumor location (parietal lobe, p=0.001), GFAP expression (≥35%, p=0.045) and serum chloride at admission (>102 mmol/l, p=0.004). In turn, EPS were independently associated with tumor location (frontal or temporal lobe, p=0.013) and pathologic laboratory values at admission (hemoglobin<12 g/dL, [p=0.044], CRP>1.0 mg/dL [p=0.036] and GGT>55 U/l [p=0.025]). Finally, SAO were associated with gross-total resection (p=0.006) and longer OS (p=0.030), whereas EPS were related to incomplete resection (p=0.005) and poorer OS (p=0.009). Conclusions In glioblastoma patients, SAO and EPS seem to have quite different triggers and contrary impact on treatment success and OS. The clinical characteristics of SAO and EPS patients might contribute the observed survival differences.

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Improved Survival with Decreased Wait Time to Surgery in Glioblastoma Patients Presenting with Seizure

Cited by 36 publications

References 20 publications

Prognostic Factors in Glioblastoma: Is There a Role for Epilepsy?

Prognostic Factors in Glioblastoma: Is There a Role for Epilepsy?

Genetic secrets of long-term glioblastoma survivors

Preoperative and early postoperative seizures in patients with glioblastoma—two sides of the same coin?

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