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Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma

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Abstract

Gliosarcoma is a rare histopathologic variant of glioblastoma traditionally associated with a poor prognosis. While gliosarcoma may represent a distinct clinical entity given its unique histologic composition and molecular features, its relative prognostic significance remains uncertain. While treatment of gliosarcoma generally encompasses the same standardized approach used in glioblastoma, supporting evidence is limited given its rarity. Here, we characterized 32 cases of gliosarcoma and retrospectively evaluated survival relative to 451 glioblastoma patients diagnosed during the same era within the same institution. Overall, we identified 22 primary gliosarcomas, representing 4.7% of WHO Grade IV primary glioblastomas, and 10 secondary gliosarcomas. With median age of 62, patients were predominately Caucasian (87.5%) and male (65.6%). Tumors with available molecular profiling were primarily MGMT-unmethylated (87.5%), IDH-1-preserved (100%) and EGFR wild-type (100%). Interestingly, while no significant median survival difference between primary gliosarcoma and glioblastoma was observed across the entire cohort (11.0 vs. 14.8 months, p = 0.269), median survival was worse for gliosarcoma specifically among patients who received modern temozolomide-based (TMZ) chemoradiotherapy (11.0 vs. 17.3 months, p = 0.006). Matched-pair analysis also trended toward worse median survival among gliosarcomas (11.0 vs. 19.6 months, log-rank p = 0.177, Breslow p = 0.010). While adjuvant radiotherapy (HR 0.206, p = 0.035) and TMZ-based chemotherapy (HR 0.531, p = 0.000) appeared protective, gliosarcoma emerged as a significantly poor prognostic factor on multivariate analysis (HR 3.27, p = 0.012). Collectively, our results suggest that gliosarcoma may still portend worse prognosis even with modern trimodality therapy.

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Acknowledgements

Dr. Wang reports personal fees and non-financial support from AbbVie, non-financial support from Merck, personal fees from AstraZeneca, personal fees from Doximity, non-financial support from Novocure, personal fees and non-financial support from Elekta and personal fees from Wolthers Kluwer, outside the submitted work.

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Authors and Affiliations

  1. Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, CHONY North B11, New York, NY, 10032, USA

    Deborah R. Smith, Cheng-Chia Wu, Heva J. Saadatmand, Steven R. Isaacson, Simon K. Cheng & Tony J. C. Wang

  2. Department of Neurological Surgery, Columbia University Medical Center, New York, NY, USA

    Steven R. Isaacson, Michael B. Sisti, Jeffrey N. Bruce, Sameer A. Sheth & Guy M. McKhann 2nd

  3. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Simon K. Cheng, Michael B. Sisti, Jeffrey N. Bruce, Andrew B. Lassman, Fabio M. Iwamoto, Peter Canoll, Guy M. McKhann 2nd & Tony J. C. Wang

  4. Department of Neurology, Columbia University Medical Center, New York, NY, USA

    Andrew B. Lassman & Fabio M. Iwamoto

  5. Department of Pathology and Cell Biology, Columbia University Medical Center, New York, NY, USA

    Shih-Hsiu Wang & Peter Canoll

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  1. Deborah R. Smith
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Correspondence to Tony J. C. Wang.

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Smith, D.R., Wu, CC., Saadatmand, H.J. et al. Clinical and molecular characteristics of gliosarcoma and modern prognostic significance relative to conventional glioblastoma. J Neurooncol 137, 303–311 (2018). https://doi.org/10.1007/s11060-017-2718-z

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  • DOI: https://doi.org/10.1007/s11060-017-2718-z

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