Prognosis of patients with multifocal glioblastoma: A case-control study

Chirag G. Patil, Anthony Yi, Adam Elramsisy, Jethro Hu, Debraj Mukherjee, Dwain K. Irvin, John S. Yu, Serguei I. Bannykh, Keith L. Black, Miriam A Nuno

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Object: The prognosis of patients with glioblastoma who present with multifocal disease is not well documented. The objective of this study was to determine whether multifocal disease on initial presentation is associated with worse survival. Methods: The authors retrospectively reviewed records of 368 patients with newly diagnosed glioblastoma and identified 47 patients with multifocal tumors. Each patient with a multifocal tumor was then matched with a patient with a solitary glioblastoma on the basis of age, Karnofsky Performance Scale (KPS) score, and extent of resection, using a propensity score matching methodology. Radiation and temozolomide treatments were also well matched between the 2 cohorts. Kaplan-Meier estimates and log-rank tests were used to compare patient survival. Results: The incidence of multifocal tumors was 12.8% (47/368). The median age of patients with multifocal tumors was 61 years, 76.6% had KPS scores ≥ 70, and 87.2% underwent either a biopsy or partial resection of their tumors. The 47 patients with multifocal tumors were almost perfectly matched on the basis of age (p = 0.97), extent of resection (p = 1.0), and KPS score (p = 0.80) compared with 47 patients with a solitary glioblastoma. Age (> 65 years), partial resection or biopsy, and low KPS score (< 70) were associated with worse median survival within the multifocal group. In the multifocal group, 19 patients experienced tumor progression on postradiation therapy MRI, compared with 11 patients (26.8%) with tumor progression in the unifocal group (p = 0.08). Patients with multifocal tumors experienced a significantly shorter median overall survival of 6 months (95% CI 4-10 months), compared with the 11-month median survival (95% CI 10-19 months) of the matched solitary glioblastoma group (p = 0.02, log-rank test). Two-year survival rates were 4.3% for patients with multifocal tumors and 29.0% for the unifocal cohort. Patients with newly diagnosed multifocal tumors were found to have an almost 2-fold increase in the hazard of death compared with patients with solitary glioblastoma (hazard ratio 1.8, 95% CI 1.1-3.1; p = 0.02). Tumor samples were analyzed for expression of phosphorylated mitogen-activated protein kinase, phosphatase and tensin homolog, O6-methylguanine-DNA methyltransferase, laminin β1 and β2, as well as epidermal growth factor receptor amplification, and no significant differences in expression profile between the multifocal and solitary glioblastoma groups was found. Conclusions: Patients with newly diagnosed multifocal glioblastoma on presentation experience significantly worse survival than patients with solitary glioblastoma. Patients with multifocal tumors continue to pose a therapeutic challenge in the temozolomide era and magnify the challenges faced while treating patients with malignant gliomas.

Original languageEnglish (US)
Pages (from-to)705-711
Number of pages7
JournalJournal of Neurosurgery
Volume117
Issue number4
DOIs
StatePublished - Oct 1 2012
Externally publishedYes

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Glioblastoma
Case-Control Studies
Neoplasms
Karnofsky Performance Status
temozolomide
Survival
Mitogen-Activated Protein Kinase Phosphatases
Biopsy
Propensity Score
Kaplan-Meier Estimate
Methyltransferases

Keywords

  • Case-control study
  • Glioblastoma
  • Multifocal
  • Oncology
  • Prognosis
  • Survival

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)
  • Clinical Neurology

Cite this

Patil, C. G., Yi, A., Elramsisy, A., Hu, J., Mukherjee, D., Irvin, D. K., ... Nuno, M. A. (2012). Prognosis of patients with multifocal glioblastoma: A case-control study. Journal of Neurosurgery, 117(4), 705-711. https://doi.org/10.3171/2012.7.JNS12147

Prognosis of patients with multifocal glioblastoma : A case-control study. / Patil, Chirag G.; Yi, Anthony; Elramsisy, Adam; Hu, Jethro; Mukherjee, Debraj; Irvin, Dwain K.; Yu, John S.; Bannykh, Serguei I.; Black, Keith L.; Nuno, Miriam A.

In: Journal of Neurosurgery, Vol. 117, No. 4, 01.10.2012, p. 705-711.

Research output: Contribution to journalArticle

Patil, CG, Yi, A, Elramsisy, A, Hu, J, Mukherjee, D, Irvin, DK, Yu, JS, Bannykh, SI, Black, KL & Nuno, MA 2012, 'Prognosis of patients with multifocal glioblastoma: A case-control study', Journal of Neurosurgery, vol. 117, no. 4, pp. 705-711. https://doi.org/10.3171/2012.7.JNS12147
Patil CG, Yi A, Elramsisy A, Hu J, Mukherjee D, Irvin DK et al. Prognosis of patients with multifocal glioblastoma: A case-control study. Journal of Neurosurgery. 2012 Oct 1;117(4):705-711. https://doi.org/10.3171/2012.7.JNS12147
Patil, Chirag G. ; Yi, Anthony ; Elramsisy, Adam ; Hu, Jethro ; Mukherjee, Debraj ; Irvin, Dwain K. ; Yu, John S. ; Bannykh, Serguei I. ; Black, Keith L. ; Nuno, Miriam A. / Prognosis of patients with multifocal glioblastoma : A case-control study. In: Journal of Neurosurgery. 2012 ; Vol. 117, No. 4. pp. 705-711.
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abstract = "Object: The prognosis of patients with glioblastoma who present with multifocal disease is not well documented. The objective of this study was to determine whether multifocal disease on initial presentation is associated with worse survival. Methods: The authors retrospectively reviewed records of 368 patients with newly diagnosed glioblastoma and identified 47 patients with multifocal tumors. Each patient with a multifocal tumor was then matched with a patient with a solitary glioblastoma on the basis of age, Karnofsky Performance Scale (KPS) score, and extent of resection, using a propensity score matching methodology. Radiation and temozolomide treatments were also well matched between the 2 cohorts. Kaplan-Meier estimates and log-rank tests were used to compare patient survival. Results: The incidence of multifocal tumors was 12.8{\%} (47/368). The median age of patients with multifocal tumors was 61 years, 76.6{\%} had KPS scores ≥ 70, and 87.2{\%} underwent either a biopsy or partial resection of their tumors. The 47 patients with multifocal tumors were almost perfectly matched on the basis of age (p = 0.97), extent of resection (p = 1.0), and KPS score (p = 0.80) compared with 47 patients with a solitary glioblastoma. Age (> 65 years), partial resection or biopsy, and low KPS score (< 70) were associated with worse median survival within the multifocal group. In the multifocal group, 19 patients experienced tumor progression on postradiation therapy MRI, compared with 11 patients (26.8{\%}) with tumor progression in the unifocal group (p = 0.08). Patients with multifocal tumors experienced a significantly shorter median overall survival of 6 months (95{\%} CI 4-10 months), compared with the 11-month median survival (95{\%} CI 10-19 months) of the matched solitary glioblastoma group (p = 0.02, log-rank test). Two-year survival rates were 4.3{\%} for patients with multifocal tumors and 29.0{\%} for the unifocal cohort. Patients with newly diagnosed multifocal tumors were found to have an almost 2-fold increase in the hazard of death compared with patients with solitary glioblastoma (hazard ratio 1.8, 95{\%} CI 1.1-3.1; p = 0.02). Tumor samples were analyzed for expression of phosphorylated mitogen-activated protein kinase, phosphatase and tensin homolog, O6-methylguanine-DNA methyltransferase, laminin β1 and β2, as well as epidermal growth factor receptor amplification, and no significant differences in expression profile between the multifocal and solitary glioblastoma groups was found. Conclusions: Patients with newly diagnosed multifocal glioblastoma on presentation experience significantly worse survival than patients with solitary glioblastoma. Patients with multifocal tumors continue to pose a therapeutic challenge in the temozolomide era and magnify the challenges faced while treating patients with malignant gliomas.",
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author = "Patil, {Chirag G.} and Anthony Yi and Adam Elramsisy and Jethro Hu and Debraj Mukherjee and Irvin, {Dwain K.} and Yu, {John S.} and Bannykh, {Serguei I.} and Black, {Keith L.} and Nuno, {Miriam A}",
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TY - JOUR

T1 - Prognosis of patients with multifocal glioblastoma

T2 - A case-control study

AU - Patil, Chirag G.

AU - Yi, Anthony

AU - Elramsisy, Adam

AU - Hu, Jethro

AU - Mukherjee, Debraj

AU - Irvin, Dwain K.

AU - Yu, John S.

AU - Bannykh, Serguei I.

AU - Black, Keith L.

AU - Nuno, Miriam A

PY - 2012/10/1

Y1 - 2012/10/1

N2 - Object: The prognosis of patients with glioblastoma who present with multifocal disease is not well documented. The objective of this study was to determine whether multifocal disease on initial presentation is associated with worse survival. Methods: The authors retrospectively reviewed records of 368 patients with newly diagnosed glioblastoma and identified 47 patients with multifocal tumors. Each patient with a multifocal tumor was then matched with a patient with a solitary glioblastoma on the basis of age, Karnofsky Performance Scale (KPS) score, and extent of resection, using a propensity score matching methodology. Radiation and temozolomide treatments were also well matched between the 2 cohorts. Kaplan-Meier estimates and log-rank tests were used to compare patient survival. Results: The incidence of multifocal tumors was 12.8% (47/368). The median age of patients with multifocal tumors was 61 years, 76.6% had KPS scores ≥ 70, and 87.2% underwent either a biopsy or partial resection of their tumors. The 47 patients with multifocal tumors were almost perfectly matched on the basis of age (p = 0.97), extent of resection (p = 1.0), and KPS score (p = 0.80) compared with 47 patients with a solitary glioblastoma. Age (> 65 years), partial resection or biopsy, and low KPS score (< 70) were associated with worse median survival within the multifocal group. In the multifocal group, 19 patients experienced tumor progression on postradiation therapy MRI, compared with 11 patients (26.8%) with tumor progression in the unifocal group (p = 0.08). Patients with multifocal tumors experienced a significantly shorter median overall survival of 6 months (95% CI 4-10 months), compared with the 11-month median survival (95% CI 10-19 months) of the matched solitary glioblastoma group (p = 0.02, log-rank test). Two-year survival rates were 4.3% for patients with multifocal tumors and 29.0% for the unifocal cohort. Patients with newly diagnosed multifocal tumors were found to have an almost 2-fold increase in the hazard of death compared with patients with solitary glioblastoma (hazard ratio 1.8, 95% CI 1.1-3.1; p = 0.02). Tumor samples were analyzed for expression of phosphorylated mitogen-activated protein kinase, phosphatase and tensin homolog, O6-methylguanine-DNA methyltransferase, laminin β1 and β2, as well as epidermal growth factor receptor amplification, and no significant differences in expression profile between the multifocal and solitary glioblastoma groups was found. Conclusions: Patients with newly diagnosed multifocal glioblastoma on presentation experience significantly worse survival than patients with solitary glioblastoma. Patients with multifocal tumors continue to pose a therapeutic challenge in the temozolomide era and magnify the challenges faced while treating patients with malignant gliomas.

AB - Object: The prognosis of patients with glioblastoma who present with multifocal disease is not well documented. The objective of this study was to determine whether multifocal disease on initial presentation is associated with worse survival. Methods: The authors retrospectively reviewed records of 368 patients with newly diagnosed glioblastoma and identified 47 patients with multifocal tumors. Each patient with a multifocal tumor was then matched with a patient with a solitary glioblastoma on the basis of age, Karnofsky Performance Scale (KPS) score, and extent of resection, using a propensity score matching methodology. Radiation and temozolomide treatments were also well matched between the 2 cohorts. Kaplan-Meier estimates and log-rank tests were used to compare patient survival. Results: The incidence of multifocal tumors was 12.8% (47/368). The median age of patients with multifocal tumors was 61 years, 76.6% had KPS scores ≥ 70, and 87.2% underwent either a biopsy or partial resection of their tumors. The 47 patients with multifocal tumors were almost perfectly matched on the basis of age (p = 0.97), extent of resection (p = 1.0), and KPS score (p = 0.80) compared with 47 patients with a solitary glioblastoma. Age (> 65 years), partial resection or biopsy, and low KPS score (< 70) were associated with worse median survival within the multifocal group. In the multifocal group, 19 patients experienced tumor progression on postradiation therapy MRI, compared with 11 patients (26.8%) with tumor progression in the unifocal group (p = 0.08). Patients with multifocal tumors experienced a significantly shorter median overall survival of 6 months (95% CI 4-10 months), compared with the 11-month median survival (95% CI 10-19 months) of the matched solitary glioblastoma group (p = 0.02, log-rank test). Two-year survival rates were 4.3% for patients with multifocal tumors and 29.0% for the unifocal cohort. Patients with newly diagnosed multifocal tumors were found to have an almost 2-fold increase in the hazard of death compared with patients with solitary glioblastoma (hazard ratio 1.8, 95% CI 1.1-3.1; p = 0.02). Tumor samples were analyzed for expression of phosphorylated mitogen-activated protein kinase, phosphatase and tensin homolog, O6-methylguanine-DNA methyltransferase, laminin β1 and β2, as well as epidermal growth factor receptor amplification, and no significant differences in expression profile between the multifocal and solitary glioblastoma groups was found. Conclusions: Patients with newly diagnosed multifocal glioblastoma on presentation experience significantly worse survival than patients with solitary glioblastoma. Patients with multifocal tumors continue to pose a therapeutic challenge in the temozolomide era and magnify the challenges faced while treating patients with malignant gliomas.

KW - Case-control study

KW - Glioblastoma

KW - Multifocal

KW - Oncology

KW - Prognosis

KW - Survival

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