Proliferation-Diffusion Modeling in Glioblastoma: Impact of Supramaximal Resection on Survival.

IF 4.5 2区 医学 Q1 ONCOLOGY
Cancers Pub Date : 2025-03-15 DOI:10.3390/cancers17060995
Maria Pia Tropeano, Zefferino Rossini, Ettore Bresciani, Andrea Franzini, Beatrice C Bono, Pierina Navarria, Elena Clerici, Matteo Simonelli, Marta Scorsetti, Marco Riva, Letterio Salvatore Politi, Federico Pessina
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Abstract

Purpose: To evaluate the role of tumor invasiveness profile in a homogeneous cohort of patients with newly diagnosed GBM (2021 WHO) that underwent SUPR by the RANO criteria, and to analyze its impact on survival outcomes.

Methods: Patients with newly diagnosed, histologically confirmed glial tumors featuring contrast-enhancing lesions, who underwent surgery at our institution between January 2007 and January 2024, were retrospectively reviewed. Preoperative total tumor volume (T-TV), contrast-enhancing (CE), and infiltrative FLAIR tumor volume (FLAIR-TV) were calculated in cubic centimeters (cc) via manual segmentation. A neuronavigation system was utilized for surgery and lesions were molecularly evaluated following the 2021 WHO CNS tumor classification. Therefore, all patients were classified into extent of resection categories by the 2022 RANO-Resect classification. The tumor invasiveness profile was assessed using the proliferation/diffusion (ρ/D) ratio, calculated following Swanson's method. A statistical analysis was finally performed.

Results: Between 2007 and 2024, 410 adult patients with newly diagnosed gliomas were treated at our institution. Methylation of the MGMT promoter was statistically significant (HR = 0.43, 95% CI: 0.20-0.94, p = 0.035), indicating that methylation has a protective effect on survival. In multivariate analysis, only MGMT status was confirmed to be an independent predictor of overall survival (OS). MGMT methylation was significantly associated with improved progression-free survival (PFS) in moderately diffuse tumors (HR = 0.18, 95% CI: 0.03-0.95, p = 0.044).

Conclusions: Using the proliferation-diffusion model to classify tumors, we identified moderately diffuse tumors with methylated MGMT status as a subgroup with significant survival benefits from SUPR.

胶质母细胞瘤的增殖-扩散模型:最大切除对生存的影响。
目的:评估肿瘤侵袭性特征在根据RANO标准接受SUPR的新诊断GBM (2021 WHO)同质队列患者中的作用,并分析其对生存结果的影响。方法:回顾性分析2007年1月至2024年1月在我院接受手术治疗的新诊断、组织学证实的神经胶质肿瘤患者的对比增强病变。术前总肿瘤体积(T-TV)、增强造影体积(CE)、浸润性FLAIR肿瘤体积(FLAIR- tv)通过人工分割计算立方厘米(cc)。神经导航系统用于手术,并根据2021年WHO中枢神经系统肿瘤分类对病变进行分子评估。因此,所有患者均按照2022 RANO-Resect分类分为切除程度类别。采用增殖/扩散(ρ/D)比评估肿瘤侵袭性,根据Swanson方法计算。最后进行统计分析。结果:2007年至2024年间,410名新诊断的成年胶质瘤患者在我院接受了治疗。MGMT启动子的甲基化具有统计学意义(HR = 0.43, 95% CI: 0.20-0.94, p = 0.035),表明甲基化对存活具有保护作用。在多变量分析中,只有MGMT状态被证实是总生存(OS)的独立预测因子。MGMT甲基化与中度弥漫性肿瘤的无进展生存期(PFS)改善显著相关(HR = 0.18, 95% CI: 0.03-0.95, p = 0.044)。结论:使用增殖-扩散模型对肿瘤进行分类,我们确定了具有MGMT甲基化状态的中度弥漫性肿瘤作为SUPR的一个亚组,其生存获益显著。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Cancers
Cancers Medicine-Oncology
CiteScore
8.00
自引率
9.60%
发文量
5371
审稿时长
18.07 days
期刊介绍: Cancers (ISSN 2072-6694) is an international, peer-reviewed open access journal on oncology. It publishes reviews, regular research papers and short communications. Our aim is to encourage scientists to publish their experimental and theoretical results in as much detail as possible. There is no restriction on the length of the papers. The full experimental details must be provided so that the results can be reproduced.
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