Factors predicting poor survival in glioblastoma

Abstract

BACKGROUNDGlioblastoma (GBM)/high-grade glioma grade IV is a debilitating diagnosis causing neurological deficits, personality changes and death. Despite recent advances in therapies, it continues to have one of the lowest one-year survival rates and, with an increasing incidence, it is imperative more research is undertaken to better understand the disease and pathophysiology.AIMIdentify demographics and molecular profile characteristics of GBMs in patients who have a survival of less than six months (short-term survivors [STS]) that carry prognostic value.METHODSOne hundred and sixty-one consecutive patients with a diagnosis of GBM from Brighton and Sussex University Hospitals were audited from January 2013 to July 2016. Patients had treatments, dates of diagnosis and dates of death recorded. All molecular pathology reports were reviewed and collated to assess trends. Data were classified into two groups, those who survived for less than six months from diagnosis and those who survived longer. Date of surgery was used as a surrogate for diagnosis date.RESULTS42.2% (n=68) patients had a survival less than six months. Of these, 34 (50.0%) had a craniotomy, in comparison to 76 (81.7%) of those who survived longer than six months. Isocitrate dehydrogenase-1 (IDH-1) testing revealed 5% of STS (n=3) had mutations, in contrast to 15% in longer-term survivors (n=14). Hypermethylation of the O6-methylguanine-DNA methyltransferase (MGMT) promoter was present in both groups with 55.6% and 62.1% in STS (n=35) and long-term survivors (n=54) respectively.CONCLUSIONThe current literature is focused on variables predicting the greatest survival in GBM patients, however there is a sparsity of studies looking at which patients will have a poorer prognosis. It is hoped analysing key molecular markers and treatment will identify factors one can use to anticipate a less favourable outcome.