Peritumoral edema on magnetic resonance imaging predicts a poor clinical outcome in malignant glioma

Abstract

����������� ����� ��TE�, ��� �� ��� ���� ����acteristics of malignant glioma, is a significant contributor to the morbidity and mortality from glioma, however, a recent systematic review suggested that controversy remains with regard to its prognostic value. To further determine whether PTE was a potential prognostic factor on routine pre‐operative ��g����� ��s������ ���g��g �MRI� ��� ����g���� g�����, ��� association between survival and PTE was investigated in the present retrospective review of 109 patients with newly diag��s�� s�p����������� ����g���� g����� �s��g MRI ���� ���� these routine scans. The Kaplan‐Meier method was used to calculate overall survival (OS) in univariate analysis, and COX proportional hazards model was applied to evaluate the effect of pre‐operative MRI features on OS in multivariate analysis. T�� �TE �x����, ����� s��p�, ��g��� �� �����s�s, ����������� �x����, p������g���� g����, p������ �g�, Karnofsky performance s����s �KPS) and post‐operative chemoradiotherapy were associated with OS in the patients with malignant glioma on univariate analysis. Multivariate analysis indicated that the extent of PTE and degree of necrosis shown by pre‐operative MRI were independent predictors of OS, in addition to pathological grade, patient age, KPS and post‐operative chemoradiotherapy. Moreover, patients with two unfavorable factors (major edema and severe necrosis) exhibited a poorer OS compared with the remainder. In summary, PTE and degree of necrosis, which are easily determined from routine MRI, can be useful for predicting a poor clinical outcome in patients with newly diagnosed malignant glioma. Introduction Malignant glioma, which consists mainly of anaplastic glioma and glioblastoma (GBM), represents up to 50% of all primary brain gliomas (1) and is the most common primary brain tumor in adults. The clinical outcome in patients with malignant glioma is poor despite the improvements in survival rate since the use of adjuvant chemoradiotherapy post‐operatively (2). It has been reported that the prognosis of malignant glioma may be affected by several factors, including not only patient age, pre‐operative Karnofsky performance status (KPS), histological grade, pathological molecular markers (such as MGMT, IDH1, 1p19q and PDGF‐α) and temozolomide chemotherapy (3‐7), but also certain pre‐operative magnetic resonance imaging (MRI) �������s �� ������� s���s, s��� �s p���������� ����� ��TE� �x����, ��g��� �� �����s�s, ����������� �x���� ��� ��� s�z� �� the cyst, among others (5,8‐11). However, several studies have also shown that certain features of pre‐operative MRI, such as PTE, cysts and tumor size, are not independent predictors of survival in patients with glioma (12‐14). PTE is a significant contributor to morbidity and mortality from glioma (15), but a recent systematic review suggested that controversy remains with regard to its prognostic value (14). A requirement therefore exists to further evaluate the association between PTE on MRI and patient survival, as such data from routine imaging are irreplaceable during the formation of a pre‐operative diagnosis and are now the central basis of treatment decisions in patients with glioma. Determination of clear associations between these factors has a certain instructive significance for clinical practice. In the present study, the prognostic value of MRI features from pre‐operative routine scans was assessed in patients with malignant glioma in order to confirm which would be the most valuable prognostic markers, as this data may provide aid in everyday clinical activities. Patients and methods Patients and clinical data. The clinical and pre‐operative MRI data of 109 patients treated by resection of a newly diagnosed supratentorial malignant glioma at the First Affiliated Hospital of Fujian Medical University (Fuzhou, China) between March 2006 and September 2012 were Peritumoral edema on magnetic resonance imaging predicts a poor clinical outcome in malignant glioma CHEN‐XING WU1*, GUO‐SHI LIN2*, ZHI‐XIONG LIN1,3, JIAN‐DONG ZHANG3, LONG CHEN3, SHUI‐YUAN LIU3, WEN‐LONG TANG3, XIAN‐XIN QIU3 ��� CHANG‐FU ZHOU2 1Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing 100093; 2Department of Neurosurgery, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian 363000; 3Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350005, P.R. China Received October 12, 2014; Accepted August 5, 2015 DOI: 10.3892/ol.2015.3639 Correspondence to: Dr Zhi‐Xiong Lin, Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, 20 Cazhong Road, Fuzhou, Fujian 350005, P.R. China E‐mail: lzx1967@sina.com *Contributed equally

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@inproceedings{Wu2015PeritumoralEO, title={Peritumoral edema on magnetic resonance imaging predicts a poor clinical outcome in malignant glioma}, author={Chen-xing Wu and Guo-shi Lin and Zhixiong Lin and Jian-Dong Zhang and Long Chen and Shui-yuan Liu and Wen-long Tang and Xian-xin Qiu and Chang-fu Zhou}, year={2015} }