Glioblastoma in the setting of prior lower grade gliomas – insights from SEER database
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Ha Son Nguyen1,3, Benjamin Best1, Ninh B. Doan1,5, Michael Gelsomino1, Saman Shabani1, Ahmed J. Awad1,4, Mayank Kaushal1 and Martin M. Mortazavi2,3
1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
2National Skull Base Center, Thousand Oaks, CA, USA
3California Institute of Neuroscience, Thousand Oaks, CA, USA
4Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
5Department of Neurosurgery, University of South Alabama, Mobile, AL, USA
Ha Son Nguyen, email: [email protected]
Keywords: glioblastoma; gliosarcoma; malignant glioma; epidemiology; SEER
Received: June 17, 2018 Accepted: July 12, 2018 Published: September 07, 2018
Introduction: Secondary glioblastomas (GBs) constitute a small subset of all GBs and tend to arise after a lower grade glioma. Though knowledge regarding this subset has gained traction in recent years, its definition continues to evolve, complicating its clinical management. Investigation of epidemiology and survival patterns may help provide needed insights.
Results: The age at GB diagnosis is significantly lower (46.22 vs 60.25 years) for group B. The distribution among type of GB (glioblastoma, giant cell glioblastoma, or gliosarcoma) was significantly different, with no diagnosis of giant cell GB in Group B. Compared to Group A, Group B exhibited a higher proportion of females, not married, smaller tumors, no GTR, and no radiation (all p < 0.05). GB-related observed survivals were comparable. Cox regression with inclusion of co-variates reveal no significant influence of GB group on observed survival. Regarding group B, mean age was 40.197 for diagnosis of initial lower grade glioma. The most common initial ICD-O-3 pathology was oligodendroglioma, NOS; astrocytoma, NOS; astrocytoma, anaplastic; and mixed glioma.
Methods: The SEER-18 registry was queried for patients with GBs. Patients were further classified into two GB groups: Group A – those with GB as the only primary tumor, and Group B – those with GB as a 2nd primary or subsequent tumor and with history of lower grade gliomas. Demographics and clinical factors were compared between group A and B. Appropriate statistics were employed to calculate incidences and differences among factors and GB-related survivals between the groups.
Conclusions: Overall, Group B develops GBs at an earlier age, but observed survival remains similar to those with GBs as the only primary. Moreover, this subset also exhibit different proportions of the types of GBs, and well as differences in other key clinical factors (namely, gender and tumor size at presentation). Prior treatments for lower grade gliomas likely explain some of the differences noted regarding management course after diagnosis of GB.
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