Prognostic relevance of CSF and peri-tumoral edema volumes in glioblastoma. (February 2021)

• Record Type: Journal Article
• Authors: Mummareddy, Nishit; Salwi, Sanjana R.; Kumar, Nishant Ganesh; Zhao, Zhiguo; Ye, Fei; Le, Chi H.; Mobley, Bret C.; Thompson, Reid C.; Chambless, Lola B.; Mistry, Akshitkumar M.
• Is Part Of: Journal of clinical neuroscience. Volume 84(2021)
• Page Start: 1
• Page End: 7
• Publication Date: 2021-02
• Subjects: Glioblastoma -- Csf -- Survival -- MRI -- GBM; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2020.12.014
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: First prognostic assessment of brain components that surround glioblastoma. Cranial CSF volume associates with survival in glioblastoma patients. Demonstration of consistent findings in two available datasets (institutional and TCGA/TCIA). Use of robust statistical and survival analyses. Abstract: Background: We conducted a segmental volumetric analysis of pre-operative brain magnetic resonance images (MRIs) of glioblastoma patients to identify brain- and tumor-related features that are prognostic of survival. Methods: Using a dataset of 210 single-institutional adult glioblastoma patients, total volumes of the following tumor- and brain-related features were quantified on pre-operative MRIs using a fully automated segmentation tool: tumor enhancement, tumor non-enhancement, tumor necrosis, peri-tumoral edema, grey matter, white matter, and cerebrospinal fluid (CSF). Their association with survival using Cox regression models, adjusting for the well-known predictors of glioblastoma survival. The findings were verified in a second dataset consisting of 96 glioblastoma patients from The Cancer Imaging Archive and The Cancer Genome Atlas (TCIA/TCGA). Results: CSF volume and edema were independently and consistently associated with overall survival of glioblastoma patients in both datasets. Greater edema was associated with increased hazard or decreased survival [adjusted hazard ratio (aHR) with 95% confidence interval (CI): 1.34 [1.08–1.67], p = 0.008 (institutional dataset); and, 1.44 [1.08–1.93], p = 0.013 (TCIA/TCGA dataset)]. Greater CSF volume also correlated with increased hazard or decreased survival [aHR 1.27 [1.02–1.59], p = 0.035 (institutional dataset), and 1.42 [1.03–1.95], p = 0.032 (TCIA/TCGA dataset)]. Conclusions: Higher brain CSF volume and higher edema levels at diagnosis are independently associated with decreased survival in glioblastoma patients. These results highlight the importance of a broader, quantitative brain-wide radiological analyses and invite investigations to understand tumor-related causes of increased edema and possibly increased CSF volume.