Maximum Resection of Noncontrast-enhanced Tumor at MRI Is a Favorable Prognostic Factor in IDH Wild-Type Glioblastoma
11
Issued Date
2025-05-01
Resource Type
eISSN
15271315
Scopus ID
2-s2.0-105004710255
Pubmed ID
40326876
Journal Title
Radiology
Volume
315
Issue
2
Rights Holder(s)
SCOPUS
Bibliographic Citation
Radiology Vol.315 No.2 (2025) , e241393
Suggested Citation
Moon H.H., Wongsawaeng D., Park J.E., Park S.Y., Baek S., Kim Y.H., Song S.W., Hong C.K., Kim J.H., Lee M.H., Park Y.W., Ahn S.S., Pollock J.M., Barajas R.F., Kim H.S. Maximum Resection of Noncontrast-enhanced Tumor at MRI Is a Favorable Prognostic Factor in IDH Wild-Type Glioblastoma. Radiology Vol.315 No.2 (2025) , e241393. doi:10.1148/radiol.241393 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110200
Title
Maximum Resection of Noncontrast-enhanced Tumor at MRI Is a Favorable Prognostic Factor in IDH Wild-Type Glioblastoma
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Isocitrate dehydrogenase (IDH) wild-type glioblastoma often includes a noncontrast-enhanced tumor (NET) component, and the extent of NET resection may serve as a prognostic marker. Purpose To assess clinical outcomes based on gross total resection (GTR) of NET, develop a real-world survival model incorporating GTR-NET for IDH wild-type glioblastoma, and validate the findings in multinational external cohorts. Materials and Methods A retrospective analysis included patients with IDH wild-type glioblastoma in a prospective registry (March 2017 to October 2020) as the training set. External validation used consecutive patients from two centers (March 2017 to January 2023). Patients were stratified into three groups: GTR-NET, GTR in contrast-enhanced tumor (CET) only, and no GTR. A conditional inference tree (CIT) model was developed using GTR type, age, and O6-methylguanine DNA methyltransferase (MGMT) promoter methylation status to predict overall survival (OS) and was externally validated. Kaplan-Meier analysis, log-rank test, time-dependent area under the receiver operating characteristic curve, and Harrell C-indexes were used for evaluation. Results In the training set (n = 201; mean age, 60 years ± 11.3; 109 males), four survival groups were identified. GTR-NET was associated with longer OS (median, 32.6 months; IQR, 18.7-46.7 months; P < .001). When GTR-NET was not achieved, OS was stratified as follows: younger than age 60 years (median OS, 23.4 months; IQR, 12.2-34.8 months), age 60 years or older and positive for MGMT (median OS, 19.1 months; IQR, 13.0-27.8 months), and age 60 years or older and negative for MGMT (median OS, 10.7 months; IQR, 6.5-14.1 months). External validation sets (352 patients in external validation set 1 and 60 patients external validation set 2) confirmed these groups (P < .001 and P = .04). Time-dependent areas under the receiver operating characteristic curve ranged from 0.684 (95% CI: 0.623, 0.745) to 0.694 (95% CI: 0.631, 0.758) and from 0.610 (95% CI: 0.449, 0.771) to 0.678 (95% CI: 0.512, 0.844), with CIT sensitivity for GTR-NET at 70.7%-77.3% and 87.6%-87.9% and C-indexes of 0.65 and 0.63. Conclusion A GTR-NET-based survival model was developed and validated, demonstrating that GTR-NET is an independent prognostic marker for longer OS in IDH-wildtype glioblastoma. ClinicalTrials.gov identifier: NCT02619890 © RSNA, 2025 Supplemental material is available for this article.