1. Tumour growth rate predicts overall survival in patients with recurrent WHO grade 4 glioma.
- Author
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Pang JHW, Saffari SE, Lee GR, Yu WY, Lim CCT, Lim KC, Lee CC, Koh WY, Chia WTD, Chua KLM, Tham CK, Low YYS, Ng WH, Low CYD, and Lin X
- Subjects
- Humans, Male, Female, Middle Aged, Retrospective Studies, Adult, Prognosis, Aged, Neoplasm Grading, Tumor Burden, Kaplan-Meier Estimate, Glioma diagnostic imaging, Glioma mortality, Glioma surgery, Glioma pathology, Neoplasm Recurrence, Local diagnostic imaging, Brain Neoplasms diagnostic imaging, Brain Neoplasms mortality, Brain Neoplasms surgery, Brain Neoplasms pathology, Magnetic Resonance Imaging methods
- Abstract
Purpose: Accurate prognostication may aid in the selection of patients who will benefit from surgery at recurrent WHO grade 4 glioma. This study aimed to evaluate the role of serial tumour volumetric measurements for prognostication at first tumour recurrence., Methods: We retrospectively analyzed patients with histologically-diagnosed WHO grade 4 glioma at initial and at first tumour recurrence at a tertiary hospital between May 2000 and September 2018. We performed auto-segmentation using ITK-SNAP software, followed by manual adjustment to measure serial contrast-enhanced T1W (CE-T1W) and T2W lesional volume changes on all MRI images performed between initial resection and repeat surgery., Results: Thirty patients met inclusion criteria; the median overall survival using Kaplan-Meier analysis from second surgery was 10.5 months. Seventeen (56.7%) patients received treatment post second surgery. Univariate cox regression analysis showed that greater rate of increase in lesional volume on CE-T1W (HR = 2.57; 95% CI [1.18, 5.57]; p = 0.02) in the last 2 MRI scans leading up to the second surgery was associated with a higher mortality likelihood. Patients with higher Karnofsky Performance Score (KPS) (HR = 0.97; 95% CI [0.95, 0.99]; p = 0.01) and who received further treatment following second surgery (HR = 0.43; 95% CI [0.19, 0.98]; p = 0.04) were shown to have a better survival., Conclusion: Higher rate of CE-T1W lesional growth on the last 2 MRI images prior to surgery at recurrence was associated with increase mortality risk. A larger prospective study is required to determine and validate the threshold to distinguish rapidly progressive tumour with poor prognosis., (© 2024. The Author(s).)
- Published
- 2024
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