Medical comorbidities prognosticate survival in glioblastoma.

Abstract

Background: Medical comorbidities are prevalent in the glioblastoma population, although their effects on survival are not well established.

Methods: We retrospectively extracted known prognostic factors and medical comorbidities at the time of glioblastoma diagnosis for 867 patients who presented to Rhode Island Hospital from 2005-2022.

Results: All established prognostic factors were represented. Median age was 65 years (range <1-93). A higher number of comorbidities was associated with older age (p < 0.0001). Having >5 comorbidities doubled the hazard ratio compared to ≤1. While comorbidity burden correlated with decreased survival, the Charlson Comorbidity Index mainly captured the effect of age (Spearman r² = 0.874) while secondarily accounting for comorbidities. In univariate analysis, hypertension, hyperlipidemia, type 2 diabetes mellitus, atrial fibrillation, stroke, chronic obstructive pulmonary disease, and other malignancies negatively influenced survival. Multivariate analysis demonstrated that tumor resection, temozolomide/radiotherapy, O⁶-methylguanine-DNA methyltransferase methylation, and bevacizumab use were protective. Pairwise analysis identified that obesity and atrial fibrillation had a higher hazard ratio of 3.3 compared to those with either or none.

Conclusions: Findings from this cohort indicate that systemic metabolism plays an important role in modulating survival, and combinatorial comorbidity analysis reveals that untreated obstructive sleep apnea is a potential risk factor for worsened outcomes.