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Clinical Epidemiology and Ageing

Prognostic factors for survival in adult patients with recurrent glioblastoma: a decision-tree-based model.

Audureau E, Chivet A, Ursu R, Corns R, Metellus P, Noel G, Zouaoui S, Guyotat J, Le Reste P-J, Faillot T, Litre F, Desse N, Petit A, Emery E, Lechapt-Zalcman E, Peltier J, Duntze J, Dezamis E, Voirin J, Menei P, Caire F, Hieu PDam, Barat J-L, Langlois O, Vignes J-R, Fabbro-Peray P, Riondel A, Sorbets E, Zanello M, Roux A, Carpentier A, Bauchet L, Pallud J J Neurooncol. 2018;136(3):565-576.

We assessed prognostic factors in relation to OS from progression in recurrent glioblastomas. Retrospective multicentric study enrolling 407 (training set) and 370 (external validation set) adult patients with a recurrent supratentorial glioblastoma treated by surgical resection and standard combined chemoradiotherapy as first-line treatment. Four complementary multivariate prognostic models were evaluated: Cox proportional hazards regression modeling, single-tree recursive partitioning, random survival forest, conditional random forest. Median overall survival from progression was 7.6 months (mean, 10.1; range, 0-86) and 8.0 months (mean, 8.5; range, 0-56) in the training and validation sets, respectively (p = 0.900). Using the Cox model in the training set, independent predictors of poorer overall survival from progression included increasing age at histopathological diagnosis (aHR, 1.47; 95% CI [1.03-2.08]; p = 0.032), RTOG-RPA V-VI classes (aHR, 1.38; 95% CI [1.11-1.73]; p = 0.004), decreasing KPS at progression (aHR, 3.46; 95% CI [2.10-5.72]; p < 0.001), while independent predictors of longer overall survival from progression included surgical resection (aHR, 0.57; 95% CI [0.44-0.73]; p < 0.001) and chemotherapy (aHR, 0.41; 95% CI [0.31-0.55]; p < 0.001). Single-tree recursive partitioning identified KPS at progression, surgical resection at progression, chemotherapy at progression, and RTOG-RPA class at histopathological diagnosis, as main survival predictors in the training set, yielding four risk categories highly predictive of overall survival from progression both in training (p < 0.0001) and validation (p < 0.0001) sets. Both random forest approaches identified KPS at progression as the most important survival predictor. Age, KPS at progression, RTOG-RPA classes, surgical resection at progression and chemotherapy at progression are prognostic for survival in recurrent glioblastomas and should inform the treatment decisions.

DOI: 10.1007/s11060-017-2685-4

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