Journal of Neuro-Oncology

, Volume 127, Issue 2, pp 355–362 | Cite as

Clinical outcome of gliosarcoma compared with glioblastoma multiforme: a clinical study in Chinese patients

  • Guobin Zhang
  • Shengyue Huang
  • Junting Zhang
  • Zhen Wu
  • Song Lin
  • Yonggang Wang
Clinical Study


Gliosarcoma (GSM) is a rare biphasic neoplasms of the central nervous system composed of a glioblastoma multiforme (GBM) admixed with a sarcomatous component. In clinical practice GSM is generally managed similarly to GBM. However, there are conflicting reports regarding their clinical aggressiveness, cell line of origin and possible prognosis compared with those of GBM. The objective of this study was to compare clinic-pathological features in GSM patients with the GBM patients during the same study period. 518 patients with GBM were treated at our hospital between 2008 and 2013, among them 51 were GSM. In this series the GSMs represented 9.8 % of all GBMs and included 58.8 % male with a median age of 44.7 years. The locations, all supratentorial, included temporal in 41.2 %, frontal in 25.5 %, parietal in 19.6 %, and occipital in 13.7 %. All patients underwent tumor resection followed by post-operative radiation and adjuvant chemotherapy. The O6-methylguanine-DNA methyltransferase promoter methylation studies were significantly more frequent in the GBMs than GSMs (80.1 % vs. 44.7 %, P < 0.001). The median progression free survival and overall survival for the patients with GSM were 8.0 and 13.0 months, respectively, as compared with 9.0 and 14.0 months in the GBM group (log rank test P = 0.001 and 0.004, respectively). The Cox proportional hazards regression model indicated that the extent of tumor resection (HR = 1.518, P = 0.009) and pathological types (HR = 0.608, P = 0.002) were the significant prognostic factors in our own series. With regard to clinical features and outcomes, GSM and GBM cannot be distinguished clinically. GSM in China may be managed similarly to GBM, with maximal safe surgical resection followed by chemo-radiotherapy. Our study adds further evidence to support GSM as a unique clinical entity with a likely worse prognosis than GBM.


Gliosarcoma Glioblastoma multiforme Prognosis 


  1. 1.
    Zhang BY, Chen H, Geng DY, Yin B, Li YX, Zhong P, Wu JS, Wang XQ (2011) Computed tomography and magnetic resonance features of gliosarcoma: a study of 54 cases. J Comput Assist Tomogr 35:667–673CrossRefPubMedGoogle Scholar
  2. 2.
    Lutterbach J, Guttenberger R, Pagenstecher A (2001) Gliosarcoma: a clinical study. Radiother Oncol 61:57–64CrossRefPubMedGoogle Scholar
  3. 3.
    Miller CR, Perry A (2007) Glioblastoma. Arch Pathol Lab Med 131:397–406PubMedGoogle Scholar
  4. 4.
    Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, Scheithauer BW, Kleihues P (2007) The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 114:97–109CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Kozak KR, Mahadevan A, Moody JS (2009) Adult gliosarcoma: epidemiology, natural history, and factors associated with outcome. Neuro Oncol 11:183–191CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Biswas A, Kumar N, Kumar P, Vasishta RK, Gupta K, Sharma SC, Patel F, Mathuriya SN (2011) Primary gliosarcoma–clinical experience from a regional cancer centre in north India. Br J Neurosurg 25:723–729CrossRefPubMedGoogle Scholar
  7. 7.
    Galanis E, Buckner JC, Dinapoli RP, Scheithauer BW, Jenkins RB, Wang CH, O’Fallon JR, Farr GJ (1998) Clinical outcome of gliosarcoma compared with glioblastoma multiforme: North Central Cancer Treatment Group results. J Neurosurg 89:425–430CrossRefPubMedGoogle Scholar
  8. 8.
    Han SJ, Yang I, Tihan T, Prados MD, Parsa AT (2010) Primary gliosarcoma: key clinical and pathologic distinctions from glioblastoma with implications as a unique oncologic entity. J Neurooncol 96:313–320CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Damodaran O, van Heerden J, Nowak AK, Bynevelt M, McDonald K, Marsh J, Lee G (2014) Clinical management and survival outcomes of gliosarcomas in the era of multimodality therapy. J Clin Neurosci 21:478–481CrossRefPubMedGoogle Scholar
  10. 10.
    Karremann M, Rausche U, Fleischhack G, Nathrath M, Pietsch T, Kramm CM, Wolff JE (2010) Clinical and epidemiological characteristics of pediatric gliosarcomas. J Neurooncol 97:257–265CrossRefPubMedGoogle Scholar
  11. 11.
    Okami N, Kawamata T, Kubo O, Yamane F, Kawamura H, Hori T (2002) Infantile gliosarcoma: a case and a review of the literature. Childs Nerv Syst 18:351–355CrossRefPubMedGoogle Scholar
  12. 12.
    Perry JR, Ang LC, Bilbao JM, Muller PJ (1995) Clinicopathologic features of primary and postirradiation cerebral gliosarcoma. Cancer 75:2910–2918CrossRefPubMedGoogle Scholar
  13. 13.
    Kumar P, Singh S, Kumar P, Krishnani N, Datta NR (2008) Gliosarcoma: an audit from a single institution in India of 24 post-irradiated cases over 15 years. J Cancer Res Ther 4:164–168CrossRefPubMedGoogle Scholar
  14. 14.
    Salvati M, Caroli E, Raco A, Giangaspero F, Delfini R, Ferrante L (2005) Gliosarcomas: analysis of 11 cases do two subtypes exist? J Neurooncol 74:59–63CrossRefPubMedGoogle Scholar
  15. 15.
    Morantz RA, Feigin I, Ransohoff JR (1976) Clinical and pathological study of 24 cases of gliosarcoma. J Neurosurg 45:398–408CrossRefPubMedGoogle Scholar
  16. 16.
    Recinos VR, Tyler BM, Bekelis K, Sunshine SB, Vellimana A, Li KW, Brem H (2010) Combination of intracranial temozolomide with intracranial carmustine improves survival when compared with either treatment alone in a rodent glioma model. Neurosurgery 66:530–537CrossRefPubMedGoogle Scholar
  17. 17.
    Scott AW, Tyler BM, Masi BC, Upadhyay UM, Patta YR, Grossman R, Basaldella L, Langer RS, Brem H, Cima MJ (2011) Intracranial microcapsule drug delivery device for the treatment of an experimental gliosarcoma model. Biomaterials 32:2532–2539CrossRefPubMedGoogle Scholar
  18. 18.
    Lee D, Kang SY, Suh YL, Jeong JY, Lee JI, Nam DH (2012) Clinicopathologic and genomic features of gliosarcomas. J Neurooncol 107:643–650CrossRefPubMedGoogle Scholar
  19. 19.
    Han SJ, Yang I, Tihan T, Chang SM, Parsa AT (2010) Secondary gliosarcoma: a review of clinical features and pathological diagnosis. J Neurosurg 112:26–32CrossRefPubMedGoogle Scholar
  20. 20.
    Han SJ, Yang I, Otero JJ, Ahn BJ, Tihan T, McDermott MW, Berger MS, Chang SM, Parsa AT (2010) Secondary gliosarcoma after diagnosis of glioblastoma: clinical experience with 30 consecutive patients. J Neurosurg 112:990–996CrossRefPubMedGoogle Scholar
  21. 21.
    Pettorini BL, Park YS, Caldarelli M, Massimi L, Tamburrini G, Di Rocco C (2008) Radiation-induced brain tumours after central nervous system irradiation in childhood: a review. Childs Nerv Syst 24:793–805CrossRefPubMedGoogle Scholar
  22. 22.
    Feigin I, Allen LB, Lipkin L, Gross SW (1958) The endothelial hyperplasia of the cerebral blood vessels with brain tumors, and its sarcomatous transformation. Cancer 11:264–277CrossRefPubMedGoogle Scholar
  23. 23.
    Rodriguez FJ, Scheithauer BW, Jenkins R, Burger PC, Rudzinskiy P, Vlodavsky E, Schooley A, Landolfi J (2007) Gliosarcoma arising in oligodendroglial tumors (“oligosarcoma”): a clinicopathologic study. Am J Surg Pathol 31:351–362CrossRefPubMedGoogle Scholar
  24. 24.
    Reis RM, Konu-Lebleblicioglu D, Lopes JM, Kleihues P, Ohgaki H (2000) Genetic profile of gliosarcomas. Am J Pathol 156:425–432CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Schittenhelm J, Erdmann T, Maennlin S, Will BE, Beschorner R, Bornemann A, Meyermann R, Mittelbronn M (2007) Gliosarcoma with chondroid and osseous differentiation. Neuropathology 27:90–94CrossRefPubMedGoogle Scholar
  26. 26.
    Shintaku M, Miyaji K, Adachi Y (1998) Gliosarcoma with angiosarcomatous features: a case report. Brain Tumor Pathol 15:101–105CrossRefPubMedGoogle Scholar
  27. 27.
    Albrecht S, Connelly JH, Bruner JM (1993) Distribution of p53 protein expression in gliosarcomas: an immunohistochemical study. Acta Neuropathol 85:222–226PubMedGoogle Scholar
  28. 28.
    Behling E, Birbe R, Veznadaroglu E, Andrews DW, Flanders A, Kenyon LC (2004) Gliosarcoma arising from an anaplastic ependymoma: a case report of a rare entity. Hum Pathol 35:512–516CrossRefPubMedGoogle Scholar
  29. 29.
    Karremann M, Rausche U, Fleischhack G, Nathrath M, Pietsch T, Kramm CM, Wolff JE (2010) Clinical and epidemiological characteristics of pediatric gliosarcomas. J Neurooncol 97:257–265CrossRefPubMedGoogle Scholar
  30. 30.
    Witwer BP, Salamat MS, Resnick DK (2000) Gliosarcoma metastatic to the cervical spinal cord: case report and review of the literature. Surg Neurol 54:373–379CrossRefPubMedGoogle Scholar
  31. 31.
    Pietschmann S, von Bueren AO, Kerber MJ, Baumert BG, Kortmann RD, Muller K (2015) An individual patient data meta-analysis on characteristics, treatments and outcomes of glioblastoma/gliosarcoma patients with metastases outside of the central nervous system. Plos One 10:e0121592CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Pietschmann S, von Bueren AO, Henke G, Kerber MJ, Kortmann RD, Muller K (2014) An individual patient data meta-analysis on characteristics, treatments and outcomes of the glioblastoma/gliosarcoma patients with central nervous system metastases reported in literature until 2013. J Neurooncol 120:451–457CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Guobin Zhang
    • 1
  • Shengyue Huang
    • 2
  • Junting Zhang
    • 1
  • Zhen Wu
    • 1
  • Song Lin
    • 1
  • Yonggang Wang
    • 1
  1. 1.Department of Neurosurgery, China National Clinical Research Center for Neurological Diseases (NCRC-ND), Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brian Tumor, Beijing Tiantan HospitalCapital Medical UniversityBeijingPeople’s Republic of China
  2. 2.Department of Neurosurgery, Fujian Provincial HospitalFujian Medical UniversityFuzhouPeople’s Republic of China

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