The role of chemotherapy in patients with H3K27M-mutant diffuse midline gliomas: a SEER-based propensity scored matching study

Abstract

Purpose Diffuse Midline Gliomas (DMGs) represent a category of rare brain tumors with an exceedingly poor prognosis. Anatomical constraints make complete surgical resection challenging. Conventional radiotherapy is widely regarded as a means to enhance patient survival. Currently, while chemotherapy is frequently employed in clinical practice for DMGs, its full therapeutic efficacy remains incompletely understood. Methods We conducted a SEER-based propensity scored matching (PSM) study on patients with H3K27M-mutant DMGs to evaluate the role of chemotherapy in the treatment benefit of DMGs. Univariate and multivariate Cox regression model were used to evaluate the relevant factors affecting cancer specific survival (CSS). Stratification and interaction analyses were conducted to delineate the impact of demographic and clinicopathological variables. Results Patients underwent both radiotherapy and chemotherapy concurrently achieved notably longer survival times compared to those who received only radiotherapy. The CSS among patients who received chemotherapy regimens was significantly prolonged in both the PSM and non PSM cohort. Univariable Cox regression suggested that age, primary site and chemotherapy were potential prognostic factors for CSS. Multivariate Cox regression indicated patients who received radiotherapy or chemotherapy exhibited a reduced risk of mortality. Multitude demographic factors, including gender, race, marital status, household income and rural urban, as well as clinicopathological variables could affect the chemotherapy benefits of DMGs patients. Conclusion Chemotherapy as an adjuvant therapy could significantly improve the prognosis of DMGs patients under comprehensive treatment conditions. The nature of multiple factors affecting chemotherapy benefits emphasizes the necessity of tailored treatment strategies.