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Open Access 01-12-2021 | Glioblastoma | Research

A nomogram for individualized prediction of overall survival in patients with newly diagnosed glioblastoma: a real-world retrospective cohort study

Authors: Nijiati Kudulaiti, Zhirui Zhou, Chen Luo, Jie Zhang, Fengping Zhu, Jinsong Wu

Published in: BMC Surgery | Issue 1/2021

Abstract

Background

This study aimed to identify the most valuable predictors of prognosis in glioblastoma (GBM) patients and develop and validate a nomogram to estimate individualized survival probability.

Methods

We conducted a real-world retrospective cohort study of 987 GBM patients diagnosed between September 2010 and December 2018. Computer generated random numbers were used to assign patients into a training cohort (694 patients) and internal validation cohort (293 patients). A least absolute shrinkage and selection operator (LASSO)-Cox model was used to select candidate variables for the prediction model. Cox proportional hazards regression was used to estimate overall survival. Models were internally validated using the bootstrap method and generated individualized predicted survival probabilities at 6, 12, and 24 months, which were compared with actual survival.

Results

The final nomogram was developed using the Cox proportional hazards model, which was the model with best fit and calibration. Gender, age at surgery, extent of tumor resection, radiotherapy, chemotherapy, and IDH1 mutation status were used as variables. The concordance indices for 6-, 12-, 18-, and 24-month survival probabilities were 0.776, 0.677, 0.643, and 0.629 in the training set, and 0.725, 0.695, 0.652, and 0.634 in the validation set, respectively.

Conclusions

Our nomogram that assesses individualized survival probabilities (6-, 12-, and 24-month) in newly diagnosed GBM patients can assist healthcare providers in optimizing treatment and counseling patients.

Trial registration: retrospectively registered.

Ostrom QT, Gittleman H, Truitt G, et al. CBTRUS statistical report: primary brain and other central nervous system tumors diagnosed in the United States in 2011–2015. Neuro Oncol. 2018;20:iv1–86. https://doi.org/10.1093/neuonc/noy131.CrossRefPubMedPubMedCentral

Lacroix M, Abi-Said D, Fourney DR, et al. A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg. 2001;95:190–8. https://doi.org/10.3171/jns.2001.95.2.0190.CrossRefPubMed

Stupp R, Hegi ME, Mason WP, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10:459–66. https://doi.org/10.1016/S1470-2045(09)70025-7.CrossRefPubMed

Thakkar JP, Dolecek TA, Horbinski C, et al. Epidemiologic and molecular prognostic review of glioblastoma. Cancer Epidemiol Biomarkers Prev. 2014;23:1985–96. https://doi.org/10.1158/1055-9965.EPI-14-0275.CrossRefPubMedPubMedCentral

Weller M, Pfister SM, Wick W, et al. Molecular neuro-oncology in clinical practice: a new horizon. Lancet Oncol. 2013;14:e370–9. https://doi.org/10.1016/S1470-2045(13)70168-2.CrossRefPubMed

Yan H, Parsons DW, Jin G, et al. IDH1 and IDH2 mutations in gliomas. N Engl J Med. 2009;360:765–73. https://doi.org/10.1056/NEJMoa0808710.CrossRefPubMedPubMedCentral

Arita H, Narita Y, Fukushima S, et al. Upregulating mutations in the tert promoter commonly occur in adult malignant gliomas and are strongly associated with total 1p19q loss. Acta Neuropathol. 2013;126:267–76. https://doi.org/10.1007/s00401-013-1141-6.CrossRefPubMed

Killela PJ, Reitman ZJ, Jiao Y, et al. Tert promoter mutations occur frequently in gliomas and a subset of tumors derived from cells with low rates of self-renewal. Proc Natl Acad Sci U S A. 2013;110:6021–6. https://doi.org/10.1073/pnas.1303607110.CrossRefPubMedPubMedCentral

Louis DN, Perry A, Reifenberger G, et al. The 2016 world health organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131:803–20. https://doi.org/10.1007/s00401-016-1545-1.CrossRefPubMed

10.

Gorlia T, van den Bent MJ, Hegi ME, et al. Nomograms for predicting survival of patients with newly diagnosed glioblastoma: prognostic factor analysis of EORTC and NCIC trial 26981–22981/CE3. Lancet Oncol. 2008;9:29–38. https://doi.org/10.1016/S1470-2045(07)70384-4.CrossRefPubMed

11.

Gittleman H, Lim D, Kattan MW, et al. An independently validated nomogram for individualized estimation of survival among patients with newly diagnosed glioblastoma: NRG Oncology RTOG 0525 and 0825. Neuro Oncol. 2017;19:669–77. https://doi.org/10.1093/neuonc/now208.CrossRefPubMed

12.

Gittleman H, Cioffi G, Chunduru P, et al. An independently validated nomogram for isocitrate dehydrogenase-wild-type glioblastoma patient survival. Neurooncol Adv. 2019;1:vdz007. https://doi.org/10.1093/noajnl/vdz007.CrossRefPubMedPubMedCentral

13.

Zhou ZR, Wang WW, Li Y, et al. In-depth mining of clinical data: the construction of clinical prediction model with R. Ann Transl Med. 2019;7:796. https://doi.org/10.21037/atm.2019.08.63.CrossRefPubMedPubMedCentral

14.

Bauchet L, Mathieu-Daudé H, Fabbro-Peray P, et al. Oncological patterns of care and outcome for 952 patients with newly diagnosed glioblastoma in 2004. Neuro Oncol. 2010;12:725–35. https://doi.org/10.1093/neuonc/noq030.CrossRefPubMedPubMedCentral

15.

Laws ER, Parney IF, Huang W, et al. Survival following surgery and prognostic factors for recently diagnosed malignant glioma: data from the Glioma Outcomes Project. J Neurosurg. 2003;99:467–73. https://doi.org/10.3171/jns.2003.99.3.0467.CrossRefPubMed

16.

Sherwood PR, Dahman BA, Donovan HS, et al. Treatment disparities following the diagnosis of an astrocytoma. J Neurooncol. 2011;101:67–74. https://doi.org/10.1007/s11060-010-0223-8.CrossRefPubMed

17.

Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol. 2004;6:227–35. https://doi.org/10.1215/S1152851703000620.CrossRefPubMedPubMedCentral

18.

Krex D, Klink B, Hartmann C, et al. Long-term survival with glioblastoma multiforme. Brain. 2007;130:2596–606. https://doi.org/10.1093/brain/awm204.CrossRefPubMed

19.

Allahdini F, Amirjamshidi A, Reza-Zarei M, et al. Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: does maximal resection of the tumor lengthen the median survival? World Neurosurg. 2010;73:128–34. https://doi.org/10.1016/j.wneu.2009.06.001.CrossRefPubMed

20.

Kuhnt D, Becker A, Ganslandt O, et al. Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance. Neuro Oncol. 2011;13:1339–48. https://doi.org/10.1093/neuonc/nor133.CrossRefPubMedPubMedCentral

21.

Roder C, Bisdas S, Ebner FH, et al. Maximizing the extent of resection and survival benefit of patients in glioblastoma surgery: high-field iMRI versus conventional and 5-ALA-assisted surgery. Eur J Surg Oncol. 2014;40:297–304. https://doi.org/10.1016/j.ejso.2013.11.022.CrossRefPubMed

22.

D’Amico RS, Englander ZK, Canoll P, et al. Extent of resection in glioma-a review of the cutting edge. World Neurosurg. 2017;103:538–49. https://doi.org/10.1016/j.wneu.2017.04.041.CrossRefPubMed

23.

Bloch O, Han SJ, Cha S, et al. Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg. 2012;117:1032–8. https://doi.org/10.3171/2012.9.JNS12504.CrossRefPubMed

24.

Ewelt C, Goeppert M, Rapp M, et al. Glioblastoma multiforme of the elderly: the prognostic effect of resection on survival. J Neurooncol. 2011;103:611–8. https://doi.org/10.1007/s11060-010-0429-9.CrossRefPubMed

25.

Gállego Pérez-Larraya J, Delattre JY. Management of elderly patients with gliomas. Oncologist. 2014;19:1258–67. https://doi.org/10.1634/theoncologist.2014-0170.CrossRefPubMedPubMedCentral

26.

Sanai N, Polley MY, McDermott MW, et al. An extent of resection threshold for newly diagnosed glioblastomas. J Neurosurg. 2011;115:3–8. https://doi.org/10.3171/2011.2.jns10998.CrossRefPubMed

27.

Brown TJ, Brennan MC, Li M, et al. Association of the extent of resection with survival in glioblastoma: a systematic review and meta-analysis. JAMA Oncol. 2016;2:1460–9. https://doi.org/10.1001/jamaoncol.2016.1373.CrossRefPubMedPubMedCentral

28.

Parsons DW, Jones S, Zhang X, et al. An integrated genomic analysis of human glioblastoma multiforme. Science. 2008;321:1807–12. https://doi.org/10.1126/science.1164382.CrossRefPubMedPubMedCentral

29.

Balss J, Meyer J, Mueller W, et al. Analysis of the IDH1 codon 132 mutation in brain tumors. Acta Neuropathol. 2008;116:597–602. https://doi.org/10.1007/s00401-008-0455-2.CrossRefPubMed

30.

Watanabe T, Nobusawa S, Kleihues P, et al. IDH1 mutations are early events in the development of astrocytomas and oligodendrogliomas. Am J Pathol. 2009;174:1149–53. https://doi.org/10.2353/ajpath.2009.080958.CrossRefPubMedPubMedCentral

31.

Nobusawa S, Watanabe T, Kleihues P, et al. IDH1 mutations as molecular signature and predictive factor of secondary glioblastomas. Clin Cancer Res. 2009;15:6002–7. https://doi.org/10.1158/1078-0432.CCR-09-0715.CrossRefPubMed

32.

Kleihues P, Ohgaki H. Primary and secondary glioblastomas: from concept to clinical diagnosis. Neuro Oncol. 1999;1:44–51. https://doi.org/10.1093/neuonc/1.1.44.CrossRefPubMedPubMedCentral

33.

Ohgaki H, Kleihues P. The definition of primary and secondary glioblastoma. Clin Cancer Res. 2013;19:764–72. https://doi.org/10.1158/1078-0432.CCR-12-3002.CrossRefPubMed

34.

Perkins A, Liu G. Primary brain tumors in adults: diagnosis and treatment. Am Fam Physician. 2016;93:211–7.PubMed

35.

Davis ME. Glioblastoma: overview of disease and treatment. Clin J Oncol Nurs. 2016;20(5):S2–8. https://doi.org/10.1188/16.CJON.S1.2-8.CrossRefPubMedPubMedCentral

36.

Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352:987–96. https://doi.org/10.1056/NEJMoa043330.CrossRef

37.

Malmström A, Grønberg BH, Marosi C, et al. Temozolomide versus standard 6-week radiotherapy versus hypofractionated radiotherapy in patients older than 60 years with glioblastoma: the Nordic randomised, phase 3 trial. Lancet Oncol. 2012;13:916–26. https://doi.org/10.1016/S1470-2045(12)70265-6.CrossRefPubMed

38.

Wick W, Platten M, Meisner C, et al. Temozolomide chemotherapy alone versus radiotherapy alone for malignant astrocytoma in the elderly: the NOA-08 randomised, phase 3 trial. Lancet Oncol. 2012;13:707–15. https://doi.org/10.1016/S1470-2045(12)70164-X.CrossRefPubMed

Title: A nomogram for individualized prediction of overall survival in patients with newly diagnosed glioblastoma: a real-world retrospective cohort study
Authors: Nijiati Kudulaiti
Zhirui Zhou
Chen Luo
Jie Zhang
Fengping Zhu
Jinsong Wu
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Glioblastoma
Glioblastoma
Radiotherapy
Glioblastoma
Cytostatic Therapy
Published in: BMC Surgery / Issue 1/2021
Electronic ISSN: 1471-2482
DOI: https://doi.org/10.1186/s12893-021-01233-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A nomogram for individualized prediction of overall survival in patients with newly diagnosed glioblastoma: a real-world retrospective cohort study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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