Top

Published in:

01-01-2020 | Glioblastoma | Original Article

Validation and optimization of a web-based nomogram for predicting survival of patients with newly diagnosed glioblastoma

Authors: Nalee Kim, Jee Suk Chang, Chan Woo Wee, In Ah Kim, Jong Hee Chang, Hye Sun Lee, Se Hoon Kim, Seok-Gu Kang, Eui Hyun Kim, Hong In Yoon, Jun Won Kim, Chang-Ki Hong, Jaeho Cho, Eunji Kim, Tae Min Kim, Yu Jung Kim, Chul-Kee Park, Jin Wook Kim, Chae-Yong Kim, Seung Hong Choi, Jae Hyoung Kim, Sung-Hye Park, Gheeyoung Choe, Soon-Tae Lee, Il Han Kim, MD PhD, Chang-Ok Suh, MD PhD

Published in: Strahlentherapie und Onkologie | Issue 1/2020

Abstract

Purpose

To optimize and validate a current (NRG [a newly constituted National Clinical Trials Network group through National Surgical Adjuvant Breast and Bowel Project [NSABP], the Radiation Therapy Oncology Group [RTOG] and the Gynecologic Oncology Group (GOG)]) nomogram for glioblastoma patients as part of continuous validation.

Methods

We identified patients newly diagnosed with glioblastoma who were treated with temozolomide-based chemoradiotherapy between 2006 and 2016 at three large-volume hospitals. The extent of resection was determined via postoperative MRI. The discrimination and calibration abilities of the prediction algorithm were assessed; if additional factors were identified as independent prognostic factors, updated models were developed using the data from two hospitals and were externally validated using the third hospital. Models were internally validated using cross-validation and bootstrapping.

Results

A total of 837 patients met the eligibility criteria. The median overall survival (OS) was 20.0 (95% CI 18.5–21.5) months. The original nomogram was able to estimate the 6‑, 12-, and 24-month OS probabilities, but it slightly underestimated the OS values. In multivariable Cox regression analysis, MRI-defined total resection had a greater impact on OS than that shown by the original nomogram, and two additional factors—IDH1 mutation and tumor contacting subventricular zone—were newly identified as independent prognostic values. An updated nomogram incorporating these new variables outperformed the original nomogram (C-index at 6, 12, 24, and 36 months: 0.728, 0.688, 0.688, and 0.685, respectively) and was well calibrated. External validation using an independent cohort showed C‑indices of 0.787, 0.751, 0.719, and 0.702 at 6, 12, 24, and 36 months, respectively, and was well calibrated.

Conclusion

An updated and validated nomogram incorporating the contemporary parameters can estimate individual survival outcomes in patients with glioblastoma with better accuracy.

Available only for authorised users

Bell EH, Pugh SL, McElroy JP et al (2017) Molecular-based recursive partitioning analysis model for Glioblastoma in the Temozolomide era: a correlative analysis based on NRG oncology RTOG 0525. JAMA Oncol 3:784–792CrossRef

Chen J, McKay RM, Parada LF (2012) Malignant glioma: lessons from genomics, mouse models, and stem cells. Cell 149:36–47CrossRef

Choi SH, Kim JW, Chang JS et al (2017) Impact of including Peritumoral edema in radiotherapy target volume on patterns of failure in Glioblastoma following Temozolomide-based Chemoradiotherapy. Sci Rep 7:42148CrossRef

Curran WJ Jr., Scott CB, Horton J et al (1993) Recursive partitioning analysis of prognostic factors in three Radiation Therapy Oncology Group malignant glioma trials. J Natl Cancer Inst 85:704–710CrossRef

Elicin O, Inac E, Uzel EK et al (2014) Relationship between survival and increased radiation dose to subventricular zone in glioblastoma is controversial. J Neurooncol 118:413–419CrossRef

GBD Mortality and Causes of Death Collaborators (2015) Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385:117–171CrossRef

Gittleman H, Lim D, Kattan MW et al (2017) An independently validated nomogram for individualized estimation of survival among patients with newly diagnosed glioblastoma: NRG Oncology RTOG 0525 and 0825. Neuro-Oncology 19:669–677CrossRef

Iasonos A, Schrag D, Raj GV et al (2008) How to build and interpret a nomogram for cancer prognosis. J Clin Oncol 26:1364–1370CrossRef

Ingrisch M, Schneider MJ, Norenberg D et al (2017) Radiomic analysis reveals prognostic information in T1-weighted baseline magnetic resonance imaging in patients with Glioblastoma. Invest Radiol 52:360–366CrossRef

10.

Jafri NF, Clarke JL, Weinberg V et al (2013) Relationship of glioblastoma multiforme to the subventricular zone is associated with survival. Neuro-Oncology 15:91–96CrossRef

11.

Kickingereder P, Bonekamp D, Nowosielski M et al (2016) Radiogenomics of Glioblastoma: machine learning-based classification of molecular characteristics by using Multiparametric and Multiregional MR imaging features. Radiology 281:907–918CrossRef

12.

Kim YS, Kim SH, Cho J et al (2012) MGMT gene promoter methylation as a potent prognostic factor in glioblastoma treated with temozolomide-based chemoradiotherapy: a single-institution study. Int J Radiat Oncol Biol Phys 84:661–667CrossRef

13.

Lacroix M, Abi-Said D, Fourney DR et al (2001) A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:190–198CrossRef

14.

Lacroix M, Toms SA (2014) Maximum safe resection of glioblastoma multiforme. J Clin Oncol 32:727–728CrossRef

15.

Lai A, Tran A, Nghiemphu PL et al (2011) Phase II study of bevacizumab plus temozolomide during and after radiation therapy for patients with newly diagnosed glioblastoma multiforme. J Clin Oncol 29:142–148CrossRef

16.

Lee J, Cho J, Chang JH et al (2016) Re-irradiation for recurrent gliomas: treatment outcomes and prognostic factors. Yonsei Med J 57:824–830CrossRef

17.

Li J, Wang M, Won M et al (2011) Validation and simplification of the Radiation Therapy Oncology Group recursive partitioning analysis classification for glioblastoma. Int J Radiat Oncol Biol Phys 81:623–630CrossRef

18.

Li YM, Suki D, Hess K et al (2016) The influence of maximum safe resection of glioblastoma on survival in 1229 patients: can we do better than gross-total resection? J Neurosurg 124:977–988CrossRef

19.

Liang TH, Kuo SH, Wang CW et al (2016) Adverse prognosis and distinct progression patterns after concurrent chemoradiotherapy for glioblastoma with synchronous subventricular zone and corpus callosum invasion. Radiother Oncol 118:16–23CrossRef

20.

Lim DA, Cha S, Mayo MC et al (2007) Relationship of glioblastoma multiforme to neural stem cell regions predicts invasive and multifocal tumor phenotype. Neuro-Oncology 9:424–429CrossRef

21.

Marko NF, Weil RJ, Schroeder JL et al (2014) Extent of resection of glioblastoma revisited: personalized survival modeling facilitates more accurate survival prediction and supports a maximum-safe-resection approach to surgery. J Clin Oncol 32:774–782CrossRef

22.

Mistry AM, Dewan MC, White-Dzuro GA et al (2017) Decreased survival in glioblastomas is specific to contact with the ventricular-subventricular zone, not subgranular zone or corpus callosum. J Neurooncol 132:341–349CrossRef

23.

Molenaar RJ, Verbaan D, Lamba S et al (2014) The combination of IDH1 mutations and MGMT methylation status predicts survival in glioblastoma better than either IDH1 or MGMT alone. Neuro-Oncology 16:1263–1273CrossRef

24.

Molitoris JK, Rao YJ, Patel RA et al (2017) Multi-institutional external validation of a novel glioblastoma prognostic nomogram incorporating MGMT methylation. J Neurooncol 134:331–338CrossRef

25.

Ostrom QT, Gittleman H, Liao P et al (2017) CBTRUS Statistical Report: Primary brain and other central nervous system tumors diagnosed in the United States in 2010–2014. Neuro-Oncology 19:v1–v88CrossRef

26.

Paravati AJ, Heron DE, Landsittel D et al (2011) Radiotherapy and temozolomide for newly diagnosed glioblastoma and anaplastic astrocytoma: Validation of Radiation Therapy Oncology Group-Recursive Partitioning Analysis in the IMRT and temozolomide era. J Neurooncol 104:339–349CrossRef

27.

Perry JR, Laperriere N, O’Callaghan CJ et al (2017) Short-course radiation plus Temozolomide in elderly patients with Glioblastoma. N Engl J Med 376:1027–1037CrossRef

28.

Roh TH, Park HH, Kang SG et al (2017) Long-term outcomes of concomitant chemoradiotherapy with temozolomide for newly diagnosed glioblastoma patients: a single-center analysis. Medicine (Baltimore) 96:e7422CrossRef

29.

Scott CB, Scarantino C, Urtasun R et al (1998) Validation and predictive power of Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis classes for malignant glioma patients: a report using RTOG 90-06. Int J Radiat Oncol Biol Phys 40:51–55CrossRef

30.

Scott JG, Bauchet L, Fraum TJ et al (2012) Recursive partitioning analysis of prognostic factors for glioblastoma patients aged 70 years or older. Cancer 118:5595–5600CrossRef

31.

Sinnaeve J, Mobley BC, Ihrie RA (2018) Space invaders: brain tumor exploitation of the stem cell niche. Am J Pathol 188:29–38CrossRef

32.

Smith AW, Mehta MP, Wernicke AG (2016) Neural stem cells, the subventricular zone and radiotherapy: implications for treating glioblastoma. J Neurooncol 128:207–216CrossRef

33.

Stupp R, Hegi ME, Mason WP et al (2009) 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 10:459–466CrossRef

34.

Stupp R, Mason WP, van den Bent MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996CrossRef

35.

Wee CW, Kim E, Kim N et al (2017) Glioblastoma Novel recursive partitioning analysis classification for newly diagnosed glioblastoma: a multi-institutional study highlighting the MGMT promoter methylation and IDH1 gene mutation status. Radiother Oncol 123:106–111CrossRef

Title: Validation and optimization of a web-based nomogram for predicting survival of patients with newly diagnosed glioblastoma
Authors: Nalee Kim
Jee Suk Chang
Chan Woo Wee
In Ah Kim
Jong Hee Chang
Hye Sun Lee
Se Hoon Kim
Seok-Gu Kang
Eui Hyun Kim
Hong In Yoon
Jun Won Kim
Chang-Ki Hong
Jaeho Cho
Eunji Kim
Tae Min Kim
Yu Jung Kim
Chul-Kee Park
Jin Wook Kim
Chae-Yong Kim
Seung Hong Choi
Jae Hyoung Kim
Sung-Hye Park
Gheeyoung Choe
Soon-Tae Lee
Il Han Kim, MD PhD
Chang-Ok Suh, MD PhD
Publication date: 01-01-2020
Publisher: Springer Berlin Heidelberg
Keywords: Glioblastoma
Glioblastoma
Glioblastoma
Published in: Strahlentherapie und Onkologie / Issue 1/2020
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-019-01512-y

At a glance: The STEP trials

Springer Medicine

Validation and optimization of a web-based nomogram for predicting survival of patients with newly diagnosed glioblastoma

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Stereotactic body radiotherapy for ventricular tachycardia (cardiac radiosurgery)

Quality of life in patients with limited (1–3) brain metastases undergoing stereotactic or whole brain radiotherapy

Unerwartet hohe Mortalität nach leberchirurgischen Eingriffen in Deutschland

Low-dose total skin electron beam therapy: Quality of life improvement and clinical impact of maintenance and adjuvant treatment in patients with mycosis fungoides or Sezary syndrome

Modulation of radiation-induced oral mucositis (mouse) by dermatan sulfate: effects on differentiation processes

Role of upper abdominal reirradiation for gastrointestinal malignancies: a systematic review of cumulative dose, toxicity, and outcomes on behalf of the Re-Irradiation Working Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO)