RESUMO
As the prevalence of Type 2 Diabetes Mellitus (T2DM) and Glioblastoma (GBM) rises globally, the relationship between T2DM and GBM remains controversial. This study aims to investigate whether genetically predicted T2DM is causally associated with GBM. We performed bidirectional Mendelian randomization (MR) analysis using data from genome-wide studies on T2DM (N = 62,892) and GBM (N = 218,792) in European populations. The results of the inverse-variance weighted (IVW) approach served as the primary outcomes. We applied Cochran's Q test and MR-Egger regression for heterogeneity assessment. Leave-one-out analysis was used to evaluate whether any single SNP significantly influenced the observed effect. Our findings reveal a significant causal association between T2DM and an increased risk of GBM (OR [95% CI] 1.70 [1.09, 2.65], P = 0.019). Conversely, the reverse association between T2DM and GBM was insignificant (OR [95% CI] 1.00 [0.99, 1.01], P = 0.408) (P > 0.40). Furthermore, the results from Cochran's Q-test and funnel plots in the MR-Egger method indicated no evidence of pleiotropy between the SNPs and GBM. Additionally, we mapped causal SNPs to genes and identified 10 genes, including MACF1, C1orf185, PTGFRN, NOTCH2, ABCB10, GCKR, THADA, RBMS1, SPHKAP, and PPARG, located on chromosomes 1, 2, and 3. These genes are involved in key biological processes such as the BMP signaling pathway and various metabolic pathways relevant to both conditions. This study provides robust evidence of a significant causal relationship between T2DM and an increased risk of GBM. The identified SNP-mapped genes highlight potential biological mechanisms underlying this association.
Assuntos
Diabetes Mellitus Tipo 2 , Estudo de Associação Genômica Ampla , Glioblastoma , Análise da Randomização Mendeliana , Polimorfismo de Nucleotídeo Único , Humanos , Glioblastoma/genética , Glioblastoma/epidemiologia , Diabetes Mellitus Tipo 2/genética , Diabetes Mellitus Tipo 2/complicações , Predisposição Genética para Doença , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/epidemiologiaRESUMO
BACKGROUNDS: Primary brain tumors (PBTs) are uncommon, but they significantly increase the risk of disability and death. There is a deficiency of data concerning the epidemiology and anatomical distribution of PBTs among adults in Palestine. METHODS: A retrospective descriptive study in which data were collected from the clinical reports of Palestinian patients diagnosed with PBTs at Al-Makassed Hospital during the period (2018-2023). RESULTS: In Palestinian adolescents and adults, the incidence rate of PBTs was 3.92 per 100,000 person-years. Glioblastoma (18.8%) was the most common type identified, and it was more common in males. Non-malignant tumors were more common than malignant tumors (2.41 vs. 1.52 per 100,000). The mortality rate from PBTs was 4.8%. The most common initial symptom was headaches, and it occurred more with non-malignant tumors (57.28% vs. 42.72%, p-value < 0.001). Cerebral meninges (26.3%) were the most common location for primary brain tumors (p-value < 0.001). CONCLUSION: This is the first study of primary brain tumor epidemiology in Palestine. The overall incidence of PBTs in Palestinian adolescents and adults was 3.96 per 100,000, which was lower than the incidence rate of primary brain tumors worldwide. More studies on the epidemiology and distribution of PBTs in Palestine are recommended.
Assuntos
Neoplasias Encefálicas , Humanos , Masculino , Adolescente , Estudos Retrospectivos , Neoplasias Encefálicas/epidemiologia , Feminino , Adulto , Adulto Jovem , Incidência , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Árabes/estatística & dados numéricos , Idoso , Glioblastoma/epidemiologiaRESUMO
PURPOSE: Glioblastoma (GB) is the most common primary malignant brain tumor with the highest incidence occurring in older adults with a median age at diagnosis of 64 years old. While treatment often improves survival it brings toxicities and adverse events (AE). Here we identify sex differences in treatment patterns and AE in individuals ≥ 66 years at diagnosis with GB. METHODS: Using the SEER-Medicare dataset sex differences in adverse events were assessed using multivariable logistic regression performed to calculate the male/female odds ratio (M/F OR) and 95% confidence intervals [95% CI] of experiencing an AE adjusted for demographic variables and Elixhauser comorbidity score. RESULTS: Males with GB were more likely to receive standard of care (SOC; Surgery with concurrent radio-chemotherapy) [20%] compared to females [17%], whereas females were more likely to receive no treatment [26%] compared to males [21%]. Females with GB receiving SOC were more likely to develop gastrointestinal disorders (M/F OR = 0.76; 95% CI,0.64-0.91, p = 0.002) or blood and lymphatic system disorders (M/F OR = 0.79; 95% CI,0.66-0.95, p = 0.012). Males with GB receiving SOC were more likely to develop cardiac disorders (M/F OR = 1.21; 95% CI,1.02-1.44, p = 0.029) and renal disorders (M/F OR = 1.65; 95% CI,1.37-2.01, p < 0.001). CONCLUSIONS: Sex differences for individuals, 66 years and older, diagnosed with GB exist in treatment received and adverse events developed across different treatment modalities.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Medicare , Humanos , Masculino , Feminino , Idoso , Estados Unidos/epidemiologia , Glioblastoma/terapia , Glioblastoma/epidemiologia , Neoplasias Encefálicas/terapia , Neoplasias Encefálicas/epidemiologia , Idoso de 80 Anos ou mais , Caracteres Sexuais , Fatores Sexuais , Programa de SEER , Terapia Combinada/efeitos adversosRESUMO
OBJECTIVE: To investigate the incidence rate of primary brain tumors (PBTs) among Palestinian children over a 6-year interval. This study also aimed to identify the predominant histopathologic types identified in these children. METHODS: This retrospective epidemiologic study focused on PBTs in children (<15 years) in Palestine. The data were collected from the registry system at Al-Makassed Hospital in Jerusalem, a prominent referral institution in Palestine and the largest center for PBTs in the region, over a 6 years period from 2018 to 2023. RESULTS: The incidence rate of PBTs in children (<15 years) was 1.33 per 100,000 person-years, with a 5% mortality rate. Pilocytic astrocytoma was the most common type (24%), followed by medulloblastoma (15.2%) and glioblastoma (6.3%). About one half of the tumors in children were malignant. Headaches were the most common first sign or symptom. About 20% of brain tumors in children were situated within the ventricles, making it the most prevalent location of these tumors, followed by the cerebellum (15.19%) and frontal lobe (11.39%). CONCLUSIONS: This is the first national study in Palestine investigating PBTs in children. The crude incidence rate of primary brain tumors among Palestinian children was lower than the incidence rate in many countries around the world. It is recommended that more research be done on the epidemiology and distribution of PBTs in children in Palestine.
Assuntos
Neoplasias Encefálicas , Humanos , Criança , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/patologia , Feminino , Masculino , Pré-Escolar , Adolescente , Estudos Retrospectivos , Lactente , Incidência , Oriente Médio/epidemiologia , Árabes , Recém-Nascido , Astrocitoma/epidemiologia , Astrocitoma/patologia , Sistema de Registros , Meduloblastoma/epidemiologia , Encaminhamento e Consulta , Glioblastoma/epidemiologia , Glioblastoma/patologiaRESUMO
The reported risk factors for glioblastoma (GBM), i.e., ionizing radiation, Li-Fraumeni syndrome, Neurofibromatosis I, and Turcot syndrome, also increase the risk of other brain tumor types. Risk factors for human GBM are associated with different oncogenic mutation profiles. Pedigreed domestic dogs with a shorter nose and flatter face (brachycephalic dogs) display relatively high rates of glioma formation. The genetic profiles of canine gliomas are also idiosyncratic. The association of putatively different mutational patterns in humans and canines with GBM suggests that different oncogenic pathways can result in GBM formation. Strong epidemiological evidence for an association between exposure to chemical carcinogens and an increased risk for development of GBM is currently lacking. Ionizing radiation induces point mutations, frameshift mutations, double-strand breaks, and chromosomal insertions or deletions. Mutational profiles associated with chemical exposures overlap with the broad mutational patterns seen with ionizing radiation. Weak statistical associations between chemical exposures and GBM reported in epidemiology studies are biologically plausible. Molecular approaches comparing reproducible patterns seen in spontaneous GBM with analogous patterns found in GBMs resected from patients with known significant exposures to potentially carcinogenic chemicals can address difficulties presented by traditional exposure assessment.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Glioma , Humanos , Animais , Cães , Glioblastoma/epidemiologia , Glioblastoma/genética , Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/genética , Mutação , Fatores de RiscoRESUMO
BACKGROUND: Although the COVID-19 pandemic has exerted potential impact on patients with glioblastomas (GBMs), it remains unclear whether the survival and its related risk factors of GBM patients would be altered or not during the period spanning from pre-COVID-19 to post-COVID-19 pandemic era. This study aimed to clarify the important issues above. METHODS: Two observational cohorts were utilized, including the nationwide American cohort from the Surveillance, Epidemiology, and End-Results (SEER) and the Chinese glioblastoma cohort (CGC) at our institution during 2018-2020. Demographics, tumour features, treatment regimens and clinical outcomes were collected. Cox regression model, competing risk model, and subgroup and sensitivity analysis were used to dynamically estimate the survival and its relevant risk factors over different diagnosis years from the pre-COVID-19 (2018 and 2019) to post-COVID-19 (2020) pandemic. Causal mediation analysis was further adopted to explore the potential relationship between risk factors and mortality. RESULTS: This study included 11321 GBM cases in SEER and 226 GBM patients in CGC, respectively. Instead of the diagnostic years of 2018-2020, the prognostic risk factors, such as advanced age, bilateral tumour and absence of comprehensive therapy (surgery combined with chemoradiotherapy), were identified to persistently affect GBM survival independently during the period from 2018 to 2020 in the SEER cohort (all P < 0.05). In CGC, lack of comprehensive therapy for GBM patients were restated as survival risk factors during the same timeframe. Causal mediation analysis showed that the effect of comprehensive therapy on all-cause mortality played a determinant role (direct effect value -0.227, 95% CI -0.248 to -0.207), which was partially mediated by age (9.11%) rather than tumour laterality. CONCLUSIONS: As the timeframe shifted from pre-COVID-19 to post-COVID-19 pandemic, survival of GBM patients remained stable, yet advanced age, bilateral tumours, and passive treatment continuingly impacted GBM survival. It is necessary to optimize the comprehensive treatment for GBM patients even in the post-pandemic era.
Assuntos
Neoplasias Encefálicas , COVID-19 , Glioblastoma , Humanos , COVID-19/epidemiologia , COVID-19/mortalidade , COVID-19/terapia , Glioblastoma/terapia , Glioblastoma/epidemiologia , Glioblastoma/mortalidade , Masculino , Feminino , Pessoa de Meia-Idade , China/epidemiologia , Estados Unidos/epidemiologia , Fatores de Risco , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapia , Neoplasias Encefálicas/mortalidade , Idoso , Adulto , Estudos de Coortes , Programa de SEERRESUMO
BACKGROUND: Comprehensive analysis of brain tumor incidence and survival in the Veteran population has been lacking. METHODS: Veteran data were obtained from the Veterans Health Administration (VHA) Medical Centers via VHA Corporate Data Warehouse. Brain tumor statistics on the overall US population were generated from the Central Brain Tumor Registry of the US data. Cases were individuals (≥18 years) with a primary brain tumor, diagnosed between 2004 and 2018. The average annual age-adjusted incidence rates (AAIR) and 95% confidence intervals were estimated per 100 000 population and Kaplan-Meier survival curves evaluated overall survival outcomes among Veterans. RESULTS: The Veteran population was primarily white (78%), male (93%), and between 60 and 64 years old (18%). Individuals with a primary brain tumor in the general US population were mainly female (59%) and between 18 and 49 years old (28%). The overall AAIR of primary brain tumors from 2004 to 2018 within the Veterans Affairs cancer registry was 11.6. Nonmalignant tumors were more common than malignant tumors (AAIR:7.19 vs 4.42). The most diagnosed tumors in Veterans were nonmalignant pituitary tumors (AAIR:2.96), nonmalignant meningioma (AAIR:2.62), and glioblastoma (AAIR:1.96). In the Veteran population, survival outcomes became worse with age and were lowest among individuals diagnosed with glioblastoma. CONCLUSIONS: Differences between Veteran and US populations can be broadly attributed to demographic composition differences of these groups. Prior to this, there have been no reports on national-level incidence rates and survival outcomes for Veterans. These data provide vital information that can drive efforts to understand disease burden and improve outcomes for individuals with primary brain tumors.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Neoplasias Meníngeas , Meningioma , Veteranos , Humanos , Masculino , Feminino , Estados Unidos/epidemiologia , Pessoa de Meia-Idade , Adolescente , Adulto Jovem , Adulto , Glioblastoma/epidemiologia , Glioblastoma/terapia , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapiaRESUMO
Glioblastoma multiforme (GBM) is an aggressive variant of central nervous system gliomas that carries a dismal prognosis. Although GBM is the most frequently occurring and malignant type of glioma accounting for more than 60% of all brain tumors in adults, its overall incidence is rare, occurring at a rate of 3.21 per 100,000 persons. Little is known about the etiology of GBM, but one proposed theory is that GBM pathogenesis may be linked to a chronic inflammatory course initiated by traumatic injury to the brain. Limited case reports have suggested an association between GBMs and traumatic brain injury (TBI), but larger case-control and epidemiologic studies have been inconclusive. We present three service members (two active duty and one retired) who developed GBM near the original site of prior head trauma. Each service member's military occupation was in the special operations community and shared a common theme of TBI following head trauma/injury. The current research on the association between TBI and GBM is limited and conflicting, predominantly due to the low incidence of the disease in the general population. Evidence has indicated that TBI should be considered a chronic disease with long-term health impacts, including long-term disability, dementia, epilepsy, mental health conditions, and cardiovascular diseases. With the addition of our patients, as well as a recently published study proposing a molecular association between trauma and GBM, further research is needed to better understand the potential relationship.
Assuntos
Lesões Encefálicas Traumáticas , Neoplasias Encefálicas , Glioblastoma , Adulto , Humanos , Glioblastoma/complicações , Glioblastoma/epidemiologia , Encéfalo/patologia , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/epidemiologia , Prognóstico , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/epidemiologiaAssuntos
COVID-19 , Glioblastoma , Humanos , Glioblastoma/epidemiologia , Glioblastoma/terapia , COVID-19/epidemiologia , PandemiasRESUMO
OBJECTIVE: Racial and socioeconomic disparities in neuro-oncological care for patients with brain tumors remain underexplored. This study aimed to analyze county-level disparities in glioblastoma (GBM) care in the United States, focusing on access to surgery and the use of adjuvant temozolomide chemotherapy and radiation therapy. METHODS: Using repeated cross-sectional data from the Surveillance, Epidemiology, and End Results 17 database; the Area Health Resources File; and the American Community Survey, from 2010 to 2019, the authors performed multivariate regression analyses to understand the associations between county-level racial and socioeconomic characteristics, as well as the rates of surgery performed, delays in surgery, and use of adjuvant chemotherapy and radiation therapy for newly diagnosed GBM. RESULTS: In total, 29,609 GBM patients from 602 different US counties over a decade were included in this study. Counties with lower rates of surgery for GBM were associated with a higher percentage of Black residents (coefficient [CE] -0.001, 95% CI -0.002 to 0; p < 0.05) and being located in the Midwest (CE -0.132, 95% CI -0.195 to -0.069; p < 0.001) or West (CE -0.127, 95% CI -0.189 to -0.065; p < 0.001) relative to the Northeast. Counties with delayed surgical treatment were more likely to lack neurosurgeons (adjusted OR [aOR] 2.52, 95% CI 1.77-3.60; p < 0.001), have a higher percentage of Black residents (aOR 1.011, 95% CI 1.00-1.02; p < 0.05), and be located in the Midwest (aOR 3.042, 95% CI 1.12-8.24; p < 0.05) or West (aOR 3.175, 95% CI 1.12-8.97 p < 0.05). Counties with high rates of adjuvant radiation therapy were less likely to have higher percentages of Black residents (aOR 0.987, 95% CI 0.980-0.995; p < 0.01) and uninsured individuals (aOR 0.962, 95% CI 0.937-0.987; p < 0.01). CONCLUSIONS: Counties without neurosurgeons and those with a higher percentage of Black patients have delays in surgical care and demonstrate lower overall rates of surgery and adjuvant therapy for GBM. This study underscores the need for targeted interventions and policies that address structural barriers in healthcare access, improve equitable distribution of the neurosurgery workforce, and ensure timely and comprehensive GBM care to all populations.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Humanos , Estados Unidos/epidemiologia , Glioblastoma/epidemiologia , Glioblastoma/cirurgia , Estudos Transversais , Fatores Socioeconômicos , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Recursos em SaúdeRESUMO
BACKGROUND: No study has compared the risk of Alzheimer's disease (AD) in patients with brain tumors, gliomas, or glioblastomas with the risk in patients with other tumors. OBJECTIVE: To determine whether, compared with other tumors, brain tumors, gliomas, and glioblastomas increase the risk of AD. METHODS: This study identified a case group of 24,441 patients from the Surveillance, Epidemiology, and End Results (SEER) database who were diagnosed with only one primary tumor at ageâ>â20 years in 1975-2019 and died from AD at ageâ>â65 years as case group. The control group comprised 122,205 subjects from the SEER database who died from causes other than AD but otherwise had the same conditions as those in the case group. RESULTS: There was a significantly lower prevalence of glioma (0.074% versus 0.14%, pâ=â0.007) and glioblastoma (0.0082% versus 0.074%, pâ=â0.001) in patients who died from AD than in those who died from other causes, while brain tumors were not significantly associated with AD death (pâ=â0.227). When adjusted for factors including age at death, sex, race, tumor behavior, radiation therapy and tumor-directed surgery, glioblastoma was related to a significantly lower AD risk than other tumors (odds ratio: 0.19, 95% CI: 0.05-0.77). Additionally, patients who were older, female, American Indian/Alaska Native, had a benign tumor, radiation therapy and tumor-directed surgery had a significantly higher risk of dying from AD. CONCLUSION: Gliomas and glioblastomas were associated with a significantly lower risk of death from AD than other tumors.
Assuntos
Doença de Alzheimer , Neoplasias Encefálicas , Glioblastoma , Glioma , Humanos , Feminino , Idoso , Glioblastoma/epidemiologia , Glioblastoma/patologia , Doença de Alzheimer/epidemiologia , Glioma/patologia , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/patologiaRESUMO
BACKGROUND: Patients with a prior malignancy are at elevated risk of developing subsequent primary malignancies (SPMs). However, the risk of developing subsequent primary glioblastoma (SPGBM) in patients with a prior cancer history is poorly understood. METHODS: We used the Surveillance, Epidemiology, and End Results (SEER) database and identified patients diagnosed with non-CNS malignancy between 2000 and 2018. We calculated a modified standardized incidence ratio (M-SIR), defined as the ratio of the incidence of SPGBM among patients with initial non-CNS malignancy to the incidence of GBM in the general population, stratified by sex latency, and initial tumor location. RESULTS: Of the 5,326,172 patients diagnosed with a primary non-CNS malignancy, 3559 patients developed SPGBM (0.07%). Among patients with SPGBM, 2312 (65.0%) were men, compared to 2,706,933 (50.8%) men in the total primary non-CNS malignancy cohort. The median age at diagnosis of SPGBM was 65 years. The mean latency between a prior non-CNS malignancy and developing a SPGBM was 67.3 months (interquartile range [IQR] 27-100). Overall, patients with a primary non-CNS malignancy had a significantly elevated M-SIR (1.13, 95% CI 1.09-1.16), with a 13% increased incidence of SPGBM when compared to the incidence of developing GBM in the age-matched general population. When stratified by non-CNS tumor location, patients diagnosed with primary melanoma, lymphoma, prostate, breast, renal, or endocrine malignancies had a higher M-SIR (M-SIR ranges: 1.09-2.15). Patients with lung cancers (M-SIR 0.82, 95% CI 0.68-0.99), or stomach cancers (M-SIR 0.47, 95% CI 0.24-0.82) demonstrated a lower M-SIR. CONCLUSION: Patients with a history of prior non-CNS malignancy are at an overall increased risk of developing SPGBM relative to the incidence of developing GBM in the general population. However, the incidence of SPGBM after prior non-CNS malignancy varies by primary tumor location, with some non-CNS malignancies demonstrating either increased or decreased predisposition for SPGBM depending on tumor origin. These findings merit future investigation into whether these relationships represent treatment effects or a previously unknown shared predisposition for glioblastoma and non-CNS malignancy.
Assuntos
Glioblastoma , Linfoma , Segunda Neoplasia Primária , Masculino , Humanos , Idoso , Feminino , Glioblastoma/epidemiologia , Glioblastoma/complicações , Programa de SEER , Segunda Neoplasia Primária/etiologia , Linfoma/complicações , Incidência , Fatores de RiscoRESUMO
PURPOSE: Epilepsy is a common comorbidity in patients with glioblastoma, however, clinical data on status epilepticus (SE) in these patients is sparse. We aimed to investigate the risk factors associated with the occurrence and adverse outcomes of SE in glioblastoma patients. METHODS: We retrospectively analysed electronic medical records of patients with de-novo glioblastoma treated at our institution between 01/2006 and 01/2020 and collected data on patient, tumour, and SE characteristics. RESULTS: In the final cohort, 292/520 (56.2 %) patients developed seizures, with 48 (9.4 % of the entire cohort and 16.4 % of patients with epilepsy, PWE) experiencing SE at some point during the course of their disease. SE was the first symptom of the tumour in 6 cases (1.2 %) and the first manifestation of epilepsy in 18 PWE (6.2 %). Most SE episodes occurred postoperatively (n = 37, 77.1 %). SE occurrence in PWE was associated with postoperative seizures and drug-resistant epilepsy. Adverse outcome (in-house mortality or admission to palliative care, 10/48 patients, 20.8 %), was independently associated with higher status epilepticus severity score (STESS) and Charlson Comorbidity Index (CCI), but not tumour progression. 32/48 SE patients (66.7 %) were successfully treated with first- and second-line agents, while escalation to third-line agents was successful in 6 (12.5 %) cases. CONCLUSION: Our data suggests a link between the occurrence of SE, postoperative seizures, and drug-resistant epilepsy. Despite the dismal oncological prognosis, SE was successfully treated in 79.2 % of the cases. Higher STESS and CCI were associated with adverse SE outcomes.
Assuntos
Epilepsia Resistente a Medicamentos , Glioblastoma , Estado Epiléptico , Humanos , Glioblastoma/complicações , Glioblastoma/epidemiologia , Glioblastoma/terapia , Estudos Retrospectivos , Estado Epiléptico/epidemiologia , Estado Epiléptico/etiologia , Estado Epiléptico/terapia , Prognóstico , Convulsões/complicações , Fatores de Risco , Epilepsia Resistente a Medicamentos/tratamento farmacológico , Índice de Gravidade de DoençaAssuntos
Neoplasias Encefálicas , Glioblastoma , Transtornos Mentais , Humanos , Glioblastoma/epidemiologia , Glioblastoma/terapia , Incidência , Temozolomida , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapia , Transtornos Mentais/epidemiologiaRESUMO
BACKGROUND: Glioblastoma (GBM) is the most common brain tumor in the United States, with an annual incidence rate of 3.21 per 100,000. It is the most aggressive type of diffuse glioma and has a median survival of months after treatment. This study aims to assess the accuracy of different novel deep learning models trained on a set of simple clinical, demographic, and surgical variables to assist in clinical practice, even in areas with constrained health care infrastructure. METHODS: Our study included 37,095 patients with GBM from the SEER (Surveillance Epidemiology and End Results) database. All predictors were based on demographic, clinicopathologic, and treatment information of the cases. Our outcomes of interest were months of survival and vital status. Concordance index (C-index) and integrated Brier scores (IBS) were used to evaluate the performance of the models. RESULTS: The patient characteristics and the statistical analyses were consistent with the epidemiologic literature. The models C-index and IBS ranged from 0.6743 to 0.6918 and from 0.0934 to 0.1034, respectively. Probabilistic matrix factorization (0.6918), multitask logistic regression (0.6916), and logistic hazard (0.6916) had the highest C-index scores. The models with the lowest IBS were the probabilistic matrix factorization (0.0934), multitask logistic regression (0.0935), and logistic hazard (0.0936). These models had an accuracy (1-IBS) of 90.66%; 90.65%, and 90.64%, respectively. The deep learning algorithms were deployed on an interactive Web-based tool for practical use available via https://glioblastoma-survanalysis.herokuapp.com/. CONCLUSIONS: Novel deep learning algorithms can better predict GBM prognosis than do baseline methods and can lead to more personalized patient care regardless of extensive electronic health record availability.
Assuntos
Neoplasias Encefálicas , Aprendizado Profundo , Glioblastoma , Humanos , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/cirurgia , Demografia , Glioblastoma/epidemiologia , Glioblastoma/cirurgia , Prognóstico , Estados UnidosRESUMO
Importance: Malignant primary brain tumors cause more than 15â¯000 deaths per year in the United States. The annual incidence of primary malignant brain tumors is approximately 7 per 100â¯000 individuals and increases with age. Five-year survival is approximately 36%. Observations: Approximately 49% of malignant brain tumors are glioblastomas, and 30% are diffusely infiltrating lower-grade gliomas. Other malignant brain tumors include primary central nervous system (CNS) lymphoma (7%) and malignant forms of ependymomas (3%) and meningiomas (2%). Symptoms of malignant brain tumors include headache (50%), seizures (20%-50%), neurocognitive impairment (30%-40%), and focal neurologic deficits (10%-40%). Magnetic resonance imaging before and after a gadolinium-based contrast agent is the preferred imaging modality for evaluating brain tumors. Diagnosis requires tumor biopsy with consideration of histopathological and molecular characteristics. Treatment varies by tumor type and often includes a combination of surgery, chemotherapy, and radiation. For patients with glioblastoma, the combination of temozolomide with radiotherapy improved survival when compared with radiotherapy alone (2-year survival, 27.2% vs 10.9%; 5-year survival, 9.8% vs 1.9%; hazard ratio [HR], 0.6 [95% CI, 0.5-0.7]; P < .001). In patients with anaplastic oligodendroglial tumors with 1p/19q codeletion, probable 20-year overall survival following radiotherapy without vs with the combination of procarbazine, lomustine, and vincristine was 13.6% vs 37.1% (80 patients; HR, 0.60 [95% CI, 0.35-1.03]; P = .06) in the EORTC 26951 trial and 14.9% vs 37% in the RTOG 9402 trial (125 patients; HR, 0.61 [95% CI, 0.40-0.94]; P = .02). Treatment of primary CNS lymphoma includes high-dose methotrexate-containing regimens, followed by consolidation therapy with myeloablative chemotherapy and autologous stem cell rescue, nonmyeloablative chemotherapy regimens, or whole brain radiation. Conclusions and Relevance: The incidence of primary malignant brain tumors is approximately 7 per 100â¯000 individuals, and approximately 49% of primary malignant brain tumors are glioblastomas. Most patients die from progressive disease. First-line therapy for glioblastoma is surgery followed by radiation and the alkylating chemotherapeutic agent temozolomide.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Adulto , Humanos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Encéfalo/patologia , Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/terapia , Glioblastoma/diagnóstico , Glioblastoma/epidemiologia , Glioblastoma/terapia , Glioma/diagnóstico , Glioma/epidemiologia , Glioma/terapia , Linfoma/diagnóstico , Linfoma/epidemiologia , Linfoma/terapia , Temozolomida/uso terapêuticoRESUMO
BACKGROUND: Disparities in treatment and outcomes disproportionately affect minority ethnic and racial populations in many surgical fields. Although substantial research in racial disparities has focused on outcomes, little is known about how surgeon recommendations can be influenced by patient race. The aim of this study was to investigate racial and socioeconomic disparities in the surgical management of primary brain tumors. METHODS: In this registry-based cohort study, we used data from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) and the American College of Surgeons National Cancer Database (NCDB) in the USA for independent analysis. Adults (aged ≥20 years) with a new diagnosis of meningioma, glioblastoma, pituitary adenoma, vestibular schwannoma, astrocytoma, and oligodendroglioma, with information on tumour size and surgical recommendation were included in the analysis. The primary outcome of this study was the odds of a surgeon recommending against surgical resection at diagnosis of primary brain neoplasms. This outcome was determined using multivariable logistic regression with clinical, demographic, and socioeconomic factors. FINDINGS: This study included US national data from the SEER (1975-2016) and NCDB (2004-17) databases of adults with a new diagnosis of meningioma (SEER n=63â674; NCDB n=222â673), glioblastoma (n=35â258; n=104â047), pituitary adenoma (n=27â506; n=87â772), vestibular schwannoma (n=11â525; n=30â745), astrocytoma (n=5402; n=10â631), and oligodendroglioma (n=3977; n=9187). Independent of clinical and demographic factors, including insurance status and rural-urban continuum code, Black patients had significantly higher odds of recommendation against surgical resection of meningioma (adjusted odds ratio 1·13, 95% CI 1·06-1·21, p<0·0001), glioblastoma (1·14, 1·01-1·28, p=0·038), pituitary adenoma (1·13, 1·05-1·22, p<0·0001), and vestibular schwannoma (1·48, 1·19-1·84, p<0·0001) when compared with White patients in the SEER dataset. Additionally, patients of unknown race had significantly higher odds of recommendation against surgical resection for pituitary adenoma (1·80, 1·41-2·30, p<0·0001) and vestibular schwannoma (1·49, 1·10-2·04, p=0·011). Performing a validation analysis using the NCDB dataset confirmed these significant results for Black patients with meningioma (1·18, 1·14-1·22, p<0·0001), glioblastoma (1·19, 1·12-1·28, p<0·0001), pituitary adenoma (1·21, 1·16-1·25, p<0·0001), and vestibular schwannoma (1·19, 1·04-1·35, p=0·0085), and indicated and indicated that the findings are independent of patient comorbidities. When further restricted to the most recent decade in SEER, these inequities held true for Black patients, except those with glioblastoma (meningioma [1·18, 1·08-1·28, p<0·0001], pituitary adenoma [1·20, 1·09-1·31, p<0·0001], and vestibular schwannoma [1·54, 1·16-2·04, p=0·0031]). INTERPRETATION: Racial disparities in surgery recommendations in the USA exist for patients with primary brain tumours, independent of potential confounders including clinical, demographic, and select socioeconomic factors. Further studies are needed to understand drivers of this bias and enhance equality in surgical care. FUNDING: None.
Assuntos
Glioblastoma , Neuroma Acústico , Neoplasias Hipofisárias , Adulto , Humanos , População Branca , Disparidades em Assistência à Saúde , Estudos de Coortes , Glioblastoma/epidemiologia , Glioblastoma/cirurgiaRESUMO
BACKGROUND: Prevalence and dynamics of certain morphological variants of neuroglial brain malignancies (ICD-10 C71) are unknown in the Russian Federation. OBJECTIVE: To assess the incidence of neuroglial brain malignancies in 2000-2020 considering individual records of morphologically verified cases in the cancer registry of the Arkhangelsk region. MATERIAL AND METHODS: We analyzed overall and age-adjusted incidence of neuroglial brain malignancies in 2000-2020 considering morphological subtypes of tumor. Incidence of morphologically verified glioblastoma was assessed in detail taking into account gender, age and place of residence. Segmented regression analysis was used to assess the dynamics and significance of linear trends. RESULTS: In total, there were 1699 brain malignancies for the period from 2000 to 2020. Morphological verification was obtained in 1289 (76%) patients including 467 (27%), 92 (5%) and 307 (18%) ones with glioblastoma, anaplastic G3 glioma and G2 glioma, respectively. Percentage of glioblastoma and anaplastic gliomas increased from 23.4% and 3.9% in 2000 to 55.3% and 9.2% in 2020, respectively. Age-adjusted incidence for the entire C71 group decreased from 5.2 to 3.2 cases per 100,000 after 2015 (annual decline 7.1%). However, incidence of glioblastoma monotonously increased from 1.0 to 2.1 per 100,000 (annual increment 6.2%). Incidence was similar in men and women. Age-adjusted incidence was 50-70% higher among rural population. CONCLUSION: Significant increase (>2 times) in the incidence of glioblastoma was found over the past twenty years. Probably, it is associated with improved diagnosis and registration of this disease. In-depth analysis of morbidity and survival of patients with rare neuroglial tumors is required.
Assuntos
Neoplasias Encefálicas , Glioblastoma , Glioma , Neoplasias Encefálicas/epidemiologia , Neoplasias Encefálicas/patologia , Feminino , Glioblastoma/epidemiologia , Glioblastoma/patologia , Humanos , Incidência , Masculino , Sistema de RegistrosRESUMO
BACKGROUND AND PURPOSE: To determine the refined estimates of the surgical effects on the short- and long-term prognoses of oldest-old patients (aged ≥80 years) with glioblastomas. MATERIALS AND METHODS: Using the Surveillance, Epidemiology, and End Results registry, we identified the oldest-old patients with glioblastomas between 2005 and 2016. Propensity score matching, Kaplan-Meier analysis, Cox regression analysis, and competing risk model were used to assess the curative efficacy of the surgical treatments. Stratification and interaction analysis were performed to explore the potential interaction effects. The conditional survival rates were calculated to explore the longitudinal change in the survival probability over time. RESULTS: This study enrolled 3309 patients with a median overall survival of 3 months. The overall survival differed significantly among the different surgical groups. Considering the gross total resection as reference, subtotal resection presented adjusted subdistribution hazard ratio (95% confidence interval) of 1.197 (1.052-1.362; p < 0.001); biopsy/partial resection, 1.242 (1.083-1.424; p = 0.002); and no surgery, 1.309 (1.145-1.497; p < 0.006). Age ≥ 83 years, widowed/other status, tumor size 4-5 cm, and temporal tumors showed significant interaction effects. The adjusted subdistribution hazard ratio of radical resection was 0.729 (0.645-0.825; p < 0.001). Based on disease-specific survival, the 1-year survival rate was 18% and 26% for the non-radical and radical surgery groups, respectively. The 1-year conditional survival rates in the second year were 54% and 39% in the non-radical and radical surgery groups, respectively. The 3-year survival rates were 10% in both the groups. CONCLUSIONS: Radical surgery may have short-term benefits in the oldest-old patients with glioblastoma, with a significant increase in the 1-year survival rate. However, its contribution in the long-term outcome is limited due to decreased conditional survival rates from the second year after surgery. Prudent patient selection and improved postoperative management may be needed to promote the therapeutic efficacy of tumor resection synergistically.