Preoperative Predictors of Early Mortality Risk in Isocitrate Dehydrogenase-Wild-Type Glioblastoma Patients Treated with Standard Therapy

Abstract

Chao Zhao,1,* Longqing Li,2,* Xiaoyue Guo,1 Dixiang Song,1 Minkai Wang,1 Yixuan Zhai,1 Fengdong Yang,1 Yake Xue,1 Xinting Wei1 1Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China; 2Department of Orthopedic Surgery, The First Affiliated Hospital of Zhengzhou University, Henan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xinting WeiDepartment of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, No. 1 East Jianshe Road, District of Erqi, Henan, People’s Republic of ChinaTel +86-0371-13613860990Email [email protected]: Early identification of early mortality for glioblastoma (GBM) patients based on laboratory findings at the time of diagnosis could improve the overall survival. The study aimed to explore preoperative factors associated with higher risk of early death (within 1 year after surgery) for isocitrate dehydrogenase (IDH) -wild-type (wt) GBM patients.Patients and Methods: We conducted a retrospective analysis of 194 IDH-wt GBM patients who underwent standard treatment. The probability of dying within 1 year after gross total resection (GTR) was defined as the end point “early mortality”. Retrospective collection of predictive factors including clinical characteristics and laboratory data at diagnosis.Results: Median follow-up time after GTR was 16 months (3– 41 months). Forty-two patients died within 1 year after surgery (1‐year mortality rate: 21.6%). All potential predictive factors were assessed on univariate analyses, which revealed the following factors as associated with higher risk of early death: older age (P = 0.013), occurrence of non-seizures symptoms (P = 0.042), special tumor positions (P = 0.046), higher neutrophil-to-lymphocyte ratio (NLR) (P = 0.015), higher red blood cell distribution width (RDW) (P = 0.019), higher lactate dehydrogenase (LDH) (P = 0.005), and higher fibrinogen (FIB) (P = 0.044). In a multivariate analysis, tumor location (P = 0.012), NLR (P = 0.032) and LDH (P = 0.002) were independent predictors of early mortality. The C-index of the nomogram was 0.795. The calibration curve showed good agreement between prediction by nomogram and actual observation.Conclusion: Tumor location, preoperative elevated NLR and serum LDH level were independent predictors for 1‐year mortality after GTR. We indicate that increased preoperative NLR or LDH may guide patients to review head magnetic resonance imaging (MRI) more frequently and regularly to monitor tumor progression.Keywords: glioblastoma, early mortality, risk factors, survival

Keywords

• glioblastoma
• early mortality
• risk factors
• survival