Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma
| Autor: | Peter Canoll, Heva J. Saadatmand, Fabio M. Iwamoto, Andrew B. Lassman, Guy M. McKhann, Deborah R. Smith, Sameer A. Sheth, Michael B. Sisti, Jeffrey N. Bruce, Simon K. Cheng, Steven R. Isaacson, Shih-Hsiu Wang, Cheng-Chia Wu, Tony J. C. Wang |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty Gliosarcoma medicine.medical_treatment Article 03 medical and health sciences 0302 clinical medicine Internal medicine Biomarkers Tumor medicine Humans Survival analysis Aged Retrospective Studies Chemotherapy Temozolomide Brain Neoplasms business.industry Retrospective cohort study Middle Aged Prognosis medicine.disease Survival Analysis Radiation therapy Neurology 030220 oncology & carcinogenesis Cohort Female Neurology (clinical) Glioblastoma business 030217 neurology & neurosurgery Chemoradiotherapy medicine.drug |
| Zdroj: | J Neurooncol |
| ISSN: | 1573-7373 0167-594X |
| Popis: | Gliosarcoma is a rare histopathologic variant of glioblastoma traditionally associated with a poor prognosis. While gliosarcoma may represent a distinct clinical entity given its unique histologic composition and molecular features, its relative prognostic significance remains uncertain. While treatment of gliosarcoma generally encompasses the same standardized approach used in glioblastoma, supporting evidence is limited given its rarity. Here, we characterized thirty-two cases of gliosarcoma and retrospectively evaluated survival relative to four hundred and fifty-one glioblastoma patients diagnosed during the same era within the same institution. Overall, we identified twenty-two primary gliosarcomas, representing 4.7% of WHO Grade IV primary glioblastomas, and ten secondary gliosarcomas. With median age of 62, patients were predominately Caucasian (87.5%) and male (65.6%). Tumors with available molecular profiling were primarily MGMT-unmethylated (87.5%), IDH-1-preserved (100%) and EGFR wild-type (100%). Interestingly, while no significant median survival difference between primary gliosarcoma and glioblastoma was observed across the entire cohort (11.0 vs. 14.8 months, p=0.269), median survival was worse for gliosarcoma specifically among patients who received modern temozolomide-based (TMZ) chemoradiotherapy (11.0 vs. 17.3 months, p=0.006). Matched-pair analysis also trended toward worse median survival among gliosarcomas (11.0 vs. 19.6 months, log-rank p=0.177, Breslow p=0.010). While adjuvant radiotherapy (HR 0.206, p=0.035) and TMZ-based chemotherapy (HR 0.531, p=0.000) appeared protective, gliosarcoma emerged as a significantly poor prognostic factor on multivariate analysis (HR 3.27, p=0.012). Collectively, our results suggest that gliosarcoma may still portend worse prognosis even with modern trimodality therapy. |
| Databáze: | OpenAIRE |
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