Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas – a retrospective population based study

Löfgren, David; Valachis, Antonios; Olivecrona, Magnus

doi:10.1186/s12877-022-03478-6

Cited by 6 publications

(2 citation statements)

References 48 publications

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“…The rate of complications in our study appears comparable to similar studies, 20 , 21 as well as the 30-day mortality. 29 As for postoperative hematoma, one of the most feared intra- and postoperative complications, a CT scan without contrast was performed 6 hours after biopsy at our department as part of clinical praxis. In 39.7% of patients, a hematoma could be identified post-operatively, although it was rarely of clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Clinical experiences and learning curves from robot-assisted neurosurgical biopsies with Stealth Autoguide™

Ljungqvist,

Barchéus,

Abbas

et al. 2024

Neuro-Oncology Advances

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Background Biopsies of intracranial lesions is a cornerstone in the diagnosis of unresectable tumors to guide neurooncological treatment; however, the procedure is also associated with risks. The results from the cranial robot guidance system Stealth Autoguide™ were studied after introduction at a neurosurgical department. Primary aims include the presentation of clinical and radiological data, accuracy of radiological diagnosis, learning curves of the new technology, diagnostic yield, and precision. The secondary aim was to study complications. Methods Retrospective data inclusion was performed on patients ≥18 years undergoing biopsy with Stealth Autoguide™ due to suspected brain tumor in the first three years after introduction of the technique. Data regarding clinical characteristics, intraoperative variables, pathological diagnosis, and complications were recorded. Analyses of learning curves were performed. Results A total of 79 procedures were performed on 78 patients with a mean age of 62 years (SD 12.7, range 23-82), 30.8% were female. Tumors were often multifocal (63.3%) and supratentorial (89.9%). The diagnostic yield was 87.3%. The first-hand radiological diagnosis was correct in 62.0%. A slight decrease in operation time was observed, although not significant. The surgeon contributed to 12% of the variability. Conclusion Robot-assisted biopsies with Stealth Autoguide™ seem to be comparable, with regards to complications, to frame-based and other frame-less neurosurgical biopsies. Learning curves demonstrated no statistical differences in time of surgery and only 12% surgeon related variation (i.e. variation caused by change of performing surgeon), suggesting a successful implementation of this technical adjunct.

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Section: Discussionmentioning

confidence: 99%

Clinical experiences and learning curves from robot-assisted neurosurgical biopsies with Stealth Autoguide™

Ljungqvist,

Barchéus,

Abbas

et al. 2024

Neuro-Oncology Advances

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“…In addition, GBM treatments with the anti-vascular drug bevacizumab also show promise, and patients prescribe with this treatment show reductions in peritumor edema and corticosteroid use, and a significant increase in progression-free survival, yet overall survival did not improve. The median survival time of GBM patients is less than two years, while the five-year survival rate is only 5% (Lofgren et al 2022 ; Yang et al 2022 ).…”

Section: Introductionmentioning

confidence: 99%

HNRNPA2B1 stabilizes NFATC3 levels to potentiate its combined actions with FOSL1 to mediate vasculogenic mimicry in GBM cells

Wang,

Shi,

Zhou

et al. 2024

Cell Biol Toxicol

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Background Vasculogenic mimicry (VM) is an enigmatic physiological feature that influences blood supply within glioblastoma (GBM) tumors for their sustained growth. Previous studies identify NFATC3, FOSL1 and HNRNPA2B1 as significant mediators of VEGFR2, a key player in vasculogenesis, and their molecular relationships may be crucial for VM in GBM. Aims The aim of this study was to understand how NFATC3, FOSL1 and HNRNPA2B1 collectively influence VM in GBM. Methods We have investigated the underlying gene regulatory mechanisms for VM in GBM cell lines U251 and U373 in vitro and in vivo. In vitro cell-based assays were performed to explore the role of NFATC3, FOSL1 and HNRNPA2B1 in GBM cell proliferation, VM and migration, in the context of RNA interference (RNAi)-mediated knockdown alongside corresponding controls. Western blotting and qRT-PCR assays were used to examine VEGFR2 expression levels. CO-IP was employed to detect protein–protein interactions, ChIP was used to detect DNA–protein complexes, and RIP was used to detect RNA–protein complexes. Histochemical staining was used to detect VM tube formation in vivo. Results Focusing on NFATC3, FOSL1 and HNRNPA2B1, we found each was significantly upregulated in GBM and positively correlated with VM-like cellular behaviors in U251 and U373 cell lines. Knockdown of NFATC3, FOSL1 or HNRNPA2B1 each resulted in decreased levels of VEGFR2, a key growth factor gene that drives VM, as well as the inhibition of proliferation, cell migration and extracorporeal VM activity. Chromatin immunoprecipitation (ChIP) studies and luciferase reporter gene assays revealed that NFATC3 binds to the promoter region of VEGFR2 to enhance VEGFR2 gene expression. Notably, FOSL1 interacts with NFATC3 as a co-factor to potentiate the DNA-binding capacity of NFATC3, resulting in enhanced VM-like cellular behaviors. Also, level of NFATC3 protein in cells was enhanced through HNRNPA2B1 binding of NFATC3 mRNA. Furthermore, RNAi-mediated silencing of NFATC3, FOSL1 and HNRNPA2B1 in GBM cells reduced their capacity for tumor formation and VM-like behaviors in vivo. Conclusion Taken together, our findings identify NFATC3 as an important mediator of GBM tumor growth through its molecular and epistatic interactions with HNRNPA2B1 and FOSL1 to influence VEGFR2 expression and VM-like cellular behaviors. Graphical Abstract 1. NFATC3 binds to the promoter region of VEGFR2 to enhance VEGFR2 gene expression which leads to an increase in VM of GBM. 2. FOSL1 interacts with NFATC3 to further facilitate VEGFR2 gene expression and VM. 3. HNRNPA2B1 enhances NFATC3 mRNA stability to increase VEGFR2 expression and VM.

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Association of hospital volume with survival but not with postoperative mortality in glioblastoma patients in Belgium

Vanhauwaert,

Silversmit,

Vanschoenbeek

et al. 2024

J Neurooncol

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Objectives Standard of care treatment for glioblastoma (GBM) involves surgical resection followed by chemoradiotherapy. However, variations in treatment decisions and outcomes exist across hospitals and physicians. In Belgium, where oncological care is dispersed, the impact of hospital volume on GBM outcomes remains unexplored. This nationwide study aims to analyse interhospital variability in 30-day postoperative mortality and 1-/2-year survival for GBM patients. Methods Data collected from the Belgian Cancer Registry, identified GBM patients diagnosed between 2016 and 2019. Surgical resection and biopsy cases were identified, and hospital case load was determined. Associations between hospital volume and mortality and survival probabilities were analysed, considering patient characteristics. Statistical analysis included logistic regression for mortality and Cox proportional hazard models for survival. Results A total of 2269 GBM patients were identified (1665 underwent resection, 662 underwent only biopsy). Thirty-day mortality rates post-resection/post-biopsy were 5.1%/11.9% (target < 3%/<5%). Rates were higher in elderly patients and those with worse WHO-performance scores. No significant difference was found based on hospital case load. Survival probabilities at 1/2 years were 48.6% and 21.3% post-resection; 22.4% and 8.3% post-biopsy. Hazard ratio for all-cause death for low vs. high volume centres was 1.618 in first 0.7 year post-resection (p < 0.0001) and 1.411 in first 0.8 year post-biopsy (p = 0.0046). Conclusion While 30-day postoperative mortality rates were above predefined targets, no association between hospital volume and mortality was found. However, survival probabilities demonstrated benefits from treatment in higher volume centres, particularly in the initial months post-surgery. These variations highlight the need for continuous improvement in neuro-oncological practice and should stimulate reflection on the neuro-oncological care organisation in Belgium.

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Risk for morbidity and mortality after neurosurgery in older patients with high grade gliomas – a retrospective population based study

Cited by 6 publications

References 48 publications

Clinical experiences and learning curves from robot-assisted neurosurgical biopsies with Stealth Autoguide™

Clinical experiences and learning curves from robot-assisted neurosurgical biopsies with Stealth Autoguide™

HNRNPA2B1 stabilizes NFATC3 levels to potentiate its combined actions with FOSL1 to mediate vasculogenic mimicry in GBM cells

Association of hospital volume with survival but not with postoperative mortality in glioblastoma patients in Belgium

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