Faculty, Staff and Student Publications
Publication Date
5-15-2025
Journal
Neuro-Oncology
Abstract
Background: Following surgery, patients with newly diagnosed glioblastoma frequently enter clinical trials. Nuanced risk assessment is warranted to reduce imbalances between study arms. Here, we aimed (I) to analyze the interactive effects of residual tumor with clinical and molecular factors on outcome and (II) to define a postoperative risk assessment tool.
Methods: The response assessment in neuro-oncology (RANO) resect group retrospectively compiled an international, seven-center training cohort of patients with newly diagnosed glioblastoma. The combined associations of residual tumor with molecular or clinical factors and survival were analyzed, and recursive partitioning analysis was performed for risk modeling. The resulting model was prognostically verified in a separate external validation cohort.
Results: Our training cohort compromised 1003 patients with newly diagnosed isocitrate dehydrogenase-wildtype glioblastoma. Residual tumor, O6-methylguanine DNA methyltransferase (MGMT) promotor methylation status, age, and postoperative Karnofsky Performance Score were prognostic for survival and incorporated into regression tree analysis. By individually weighting the prognostic factors, an additive score (range, 0-9 points) integrating these four variables distinguished patients with low (0-2 points), intermediate (3-5 points), and high risk (6-9 points) for inferior survival. The prognostic value of our risk model was retained in treatment-based subgroups and confirmed in an external validation cohort of 258 patients with glioblastoma. Compared to previously postulated models, goodness-of-fit measurements were superior for our model.
Conclusions: The novel RANO risk model serves as an easy-to-use, yet highly prognostic tool for postoperative patient stratification prior to further therapy. The model may serve to guide patient management and reduce imbalances between study arms in prospective trials.
Keywords
Humans, Glioblastoma, Male, Female, Middle Aged, Brain Neoplasms, Prognosis, Retrospective Studies, Aged, Adult, Survival Rate, Risk Assessment, Follow-Up Studies, Young Adult, Neoplasm, Residual, DNA Repair Enzymes, extent of resection, glioblastoma, patient stratification, postoperative risk modeling, risk assessment
DOI
10.1093/neuonc/noae231
PMID
39492786
PMCID
PMC12083231
PubMedCentral® Posted Date
11-4-2024
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes