Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy

Abstract

The prognosis for glioblastoma (GBM) varies among patients. Ventricular opening during surgery has been reported as a prognostic factor for GBM patients, but the influence of ventricular opening itself on patient prognosis remains controversial. We presumed that the degree of ventricular opening would correlate with the degree of subventricular zone (SVZ) resection and with prognosis in GBM patients. This study therefore investigated whether the degree of ventricular opening correlates with prognosis in GBM patients treated with the standard protocol of chemo-radiotherapy. Participants comprised 111 patients with newly diagnosed GBM who underwent surgery and received postoperative radiotherapy and temozolomide-based chemotherapy from 2005 to 2018. We classified 111 patients into “No ventricular opening (NVO)”, “Ventricular opening, small (VOS; distance < 23.2 mm)”, and “Ventricular opening, wide (VOW; distance ≥ 23.2 mm)” groups. We evaluated the relationship between degree of ventricular opening and prognosis using survival analyses that included other clinicopathological factors. Log-rank testing revealed age, Karnofsky performance status (KPS), extent of resection, O6-methylguanine-DNA methyltransferase (MGMT) status, isocitrate dehydrogenase (IDH)1 mutation, and degree of ventricular opening correlated significantly with overall survival. Multivariate analysis identified the degree of ventricular opening (small vs. wide) as the most significant prognostic factor (hazard ratio = 3.674; p < 0.0001). We demonstrated that wide opening of the lateral ventricle (LV) contributes to longer survival compared with small opening among GBM patients. Our results indicate that wide opening of the LV may correlate with the removal of a larger proportion of tumor stem cells from the SVZ.

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Acknowledgments

We thank Takashi Sakayori and Asuka Komori, Department of Pathology, Tokyo Women’s Medical University, Tokyo, Japan, for the immunohistochemical staining and the molecular genetic analyses, and Soko Ikuta, Faculty of Advanced Techno-Surgery, Institute of Advanced Biomedical Engineering and Science, Tokyo Women’s Medical University, for the data analyses of patients’ clinical characteristics.

Funding

This study was supported by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant No. 18 K09006.

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Correspondence to Taiichi Saito.

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Ethical approval was obtained from the ethics committee at Tokyo Women’s Medical University (No. 3540).

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Given the retrospective design, the institutional review board waived the requirement for informed consent. We took the opt-out method. To protect patient privacy, we removed all identifiers from our records upon completion of our analyses.

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Saito, T., Muragaki, Y., Maruyama, T. et al. Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy. Neurosurg Rev 43, 1583–1593 (2020). https://doi.org/10.1007/s10143-019-01185-2

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Keywords

  • Lateral ventricle
  • Glioblastoma
  • Subventricular zone
  • Prognosis
  • Temozolomide