Confirming Diagnosis and Effective Treatment for Rare Epithelioid Glioblastoma Variant: An Integrated Survival Analysis of the Literature.

Autor: Lu VM; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: lu.victor@mayo.edu., George ND; Magdalen College, University of Oxford, Oxford, United Kingdom., Brown DA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA., Akinduro OO; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Raghunathan A; Department of Pathology, Mayo Clinic, Rochester, Minnesota, USA., Jentoft M; Department of Pathology, Mayo Clinic, Jacksonville, Florida, USA., Quinones-Hinojosa A; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA., Chaichana KL; Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2019 Nov; Vol. 131, pp. 243-251.e2. Date of Electronic Publication: 2019 Aug 09.
DOI: 10.1016/j.wneu.2019.08.007
Abstrakt: Background: Epithelioid glioblastoma (eGBM) is a very rare histologic variant of glioblastoma that has not been studied in isolation and, therefore, its optimal management has been largely assumed, but not confirmed. The aim of this study was to analyze all reported cases describing the presentation and clinical features to better understand the clinical significance of this histologic diagnosis.
Methods: A comprehensive literature search was conducted from 2005 to April 2019 identifying cases of eGBM that satisfied selection criteria for analysis. Survival was investigated using Kaplan-Meier estimations, and then univariate and multivariate logistic regression analyses for primary end point overall survival (OS) and second end point progression-free survival (PFS).
Results: A total cohort of 59 eGBM cases from 28 articles were included for final analysis. Median age of patients at diagnosis was 30 years, with 29 (46%) female patients. When reported, 100% (37/37) cases were IDH1-wild-type and 63% (19/30) were positive for the BRAF V600E mutation by immunohistochemistry. Median OS and PFS were estimated to be 11.0 months (95% confidence interval, 6.5-13.0) and 7.0 months (95% confidence interval, 3.0-10.0), respectively. Surgical extent of resection, radiation therapy, and chemotherapy all predicted superior OS and PFS on multivariate analysis (P < 0.05). No biomarkers prognosticated survival.
Conclusions: These findings indicate that the histologic diagnosis of eGBM does not deviate from the clinical course of the broader glioblastoma diagnosis, despite being a unique histologic identity. These results argue against the temptation to deviate from the traditional management paradigm of surgery, radiation, and chemotherapy for glioblastoma based on this histology alone.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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