TY - JOUR
T1 - Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor
T2 - Results from a systematic review and meta-analysis
AU - Waqar, Mueez
AU - Roncaroli, Federico
AU - Lehrer, Eric J
AU - Palmer, Joshua D
AU - Villanueva-Meyer, Javier
AU - Braunstein, Steve
AU - Hall, Emma
AU - Aznar, Marianne
AU - De Witt Hamer, Philip C
AU - D'Urso, Pietro I
AU - Trifiletti, Daniel
AU - Quiñones-Hinojosa, Alfredo
AU - Wesseling, Pieter
AU - Bors, Gerben R
N1 - © The Author(s) 2022. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - Background: In patients with newly diagnosed glioblastoma, rapid early progression (REP) refers to tumor regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised previously published data on REP to better characterize and understand it.Methods: Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to October 21, 2021. Studies describing the incidence of REP-tumor growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly diagnosed glioblastoma were included. The primary outcome was REP incidence.Results: From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0-58.8 y). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1-1.5). The median number of days between MRI scans was 34 days (IQR 18-45 days). The mean incidence rate of REP was 45.9% (range 19.3%-72.0%) and significantly lower in studies employing functional imaging to define REP (
P < .001). REP/non-REP groups were comparable with respect to age (
P = .99), gender (
P = .33) and time between scans (
P = .81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30-2.43,
P < .001), shortened progression-free survival (HR 1.78, 95% CI 1.30-2.43,
P < .001), subtotal resection (OR 6.96, 95% CI 4.51-10.73,
P < .001) and IDH wild-type versus mutant tumors (OR 0.20, 95% CI 0.02-0.38,
P = .03).
MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72-2.28,
P = .39).
Conclusions: REP occurs in almost half of patients with newly diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.
AB - Background: In patients with newly diagnosed glioblastoma, rapid early progression (REP) refers to tumor regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised previously published data on REP to better characterize and understand it.Methods: Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to October 21, 2021. Studies describing the incidence of REP-tumor growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly diagnosed glioblastoma were included. The primary outcome was REP incidence.Results: From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0-58.8 y). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1-1.5). The median number of days between MRI scans was 34 days (IQR 18-45 days). The mean incidence rate of REP was 45.9% (range 19.3%-72.0%) and significantly lower in studies employing functional imaging to define REP (
P < .001). REP/non-REP groups were comparable with respect to age (
P = .99), gender (
P = .33) and time between scans (
P = .81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30-2.43,
P < .001), shortened progression-free survival (HR 1.78, 95% CI 1.30-2.43,
P < .001), subtotal resection (OR 6.96, 95% CI 4.51-10.73,
P < .001) and IDH wild-type versus mutant tumors (OR 0.20, 95% CI 0.02-0.38,
P = .03).
MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72-2.28,
P = .39).
Conclusions: REP occurs in almost half of patients with newly diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.
U2 - 10.1093/noajnl/vdac075
DO - 10.1093/noajnl/vdac075
M3 - Article
C2 - 35769410
SN - 2632-2498
VL - 4
SP - vdac075
JO - Neuro-Oncology Advances
JF - Neuro-Oncology Advances
IS - 1
ER -