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.
Keywords
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Article info
Publication history
Accepted:
December 10,
2020
Received:
July 10,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
