AUTHOR=Jiang Haihui , Yu Kefu , Cui Yong , Ren Xiaohui , Li Mingxiao , Zhang Guobin , Yang Chuanwei , Zhao Xuzhe , Zhu Qinghui , Lin Song 

TITLE=Differential Predictors and Clinical Implications Associated With Long-Term Survivors in IDH Wildtype and Mutant Glioblastoma

JOURNAL=Frontiers in Oncology

VOLUME=11

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.632663

DOI=10.3389/fonc.2021.632663

ISSN=2234-943X

ABSTRACT=<sec><title>Background</title><p>Glioblastoma (GBM) is the most aggressive intracranial tumor which can be divided into two subtypes based on status of isocitrate dehydrogenase (IDH). A small fraction of patients after receiving standard treatment can be long-term survivors (LTS). This study was designed to disclose the predictors and clinical implications associated with LTS in IDH wildtype and mutant GBM.</p></sec><sec><title>Methods</title><p>Patients who survived beyond five years after diagnosis of GBM were defined as LTS, while those with a survival less than one year were defined as short-term survivors (STS). A total of 211 patients with diagnosis of GBM in Beijing Tiantan Hospital from January 2007 to January 2015 were enrolled, including 44 (20.9%) LTS and 167 (79.1%) STS. The clinical, radiological and molecular features between groups were systematically compared.</p></sec><sec><title>Results</title><p>Compared with STS, LTS were a subgroup of patients with a younger age at diagnosis (<italic>P</italic>=0.006), a higher KPS score (<italic>P</italic>=0.011), higher rates of cystic change (<italic>P</italic>=0.037), O<sup>6</sup>-methylguanine-DNA methyltransferase (MGMT) promoter methylation (<italic>P</italic>=0.007), and IDH mutation (<italic>P</italic>=0.049), and more likely to have undergone gross total resection (<italic>P</italic>&lt;0.001). Survival analysis demonstrated that LTS with wildtype IDH conferred a longer progression-free survival (66.0 <italic>vs.</italic> 27.0 months, <italic>P</italic>=0.04), but a shorter post-progression survival (46.5 months <italic>vs.</italic> not reached, <italic>P</italic>=0.0001) than those of LTS with mutant IDH. LTS with mutant IDH showed a trend towards increased survival after receiving re-operation (<italic>P</italic>=0.155) and reirradiation (<italic>P</italic>=0.127), while this clinical benefit disappeared in the subset of LTS with wildtype IDH (<italic>P</italic>&gt;0.05).</p></sec><sec><title>Conclusion</title><p>The prognostic value and therapeutic implications associated with LTS in GBM population significantly differed on the basis of IDH status. Our findings provide a new approach for physicians to better understand the two subtypes of GBM, which may assist in making more tailored treatment decisions for patients.</p></sec>