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01-01-2019 | Clinical Study

Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma

Authors: Stephen J. Bagley, Robert D. Schwab, Ernest Nelson, Angela N. Viaene, Zev A. Binder, Robert A. Lustig, Donald M. O’Rourke, Steven Brem, Arati S. Desai, MacLean P. Nasrallah

Published in: Journal of Neuro-Oncology | Issue 2/2019

Abstract

Purpose

The prognostic impact of the histopathologic features of recurrent glioblastoma surgical specimens is unknown. We sought to determine whether key histopathologic characteristics in glioblastoma tumors resected after chemoradiotherapy are associated with overall survival (OS).

Methods

The following characteristics were quantified in recurrent glioblastoma specimens at our institution: extent of viable tumor (accounting for % of specimen comprised of tumor and tumor cellularity), mitoses per 10 high-power fields (0, 1–10, > 10), Ki-67 proliferative index (0–100%), hyalinization (0–6; none to extensive), rarefaction (0–6), hemosiderin (0–6), and % of specimen comprised of geographic necrosis (0–100%; converted to 0–6 scale). Variables associated with OS in univariate analysis, as well as age, eastern cooperative oncology group performance status (ECOG PS), extent of repeat resection, time from initial diagnosis to repeat surgery, and O⁶-methylguanine-DNA methyltransferase promoter methylation, were included in a multivariable Cox proportional hazards model.

Results

37 specimens were assessed. In a multivariate model, high Ki-67 proliferative index was the only histopathologic characteristic associated with worse OS following repeat surgery for glioblastoma (hazard ratio (HR) 1.3, 95% CI 1.1–1.5, p = 0.003). Shorter time interval from initial diagnosis to repeat surgery (HR 1.11, 95% CI 1.02–1.21, p = 0.016) and ECOG PS ≥ 2 (HR 4.19, 95% CI 1.72–10.21, p = 0.002) were also independently associated with inferior OS.

Conclusion

In patients with glioblastoma undergoing repeat resection following chemoradiotherapy, high Ki-67 index in the recurrent specimen, short time to recurrence, and poor PS are independently associated with worse OS. Histopathologic quantification of viable tumor versus therapy-related changes has limited prognostic influence.

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Title: Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma
Authors: Stephen J. Bagley
Robert D. Schwab
Ernest Nelson
Angela N. Viaene
Zev A. Binder
Robert A. Lustig
Donald M. O’Rourke
Steven Brem
Arati S. Desai
MacLean P. Nasrallah
Publication date: 01-01-2019
Publisher: Springer US
Published in: Journal of Neuro-Oncology / Issue 2/2019
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI: https://doi.org/10.1007/s11060-018-03050-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Histopathologic quantification of viable tumor versus treatment effect in surgically resected recurrent glioblastoma

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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