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Body mass index as an independent prognostic factor in glioblastoma

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Abstract

Purpose

Glioblastoma prognosis remains dismal despite gross total removal (GTR) followed by chemoradiotherapy. Other known prognostic factors include functional status, age and IDH mutation status. However, to improve patient outcome, a search for other features with impact on survival is needed. We aimed to analyse the impact of body mass index (BMI) on overall survival (OS) and progression-free survival (PFS) of surgically resected primary glioblastoma and evaluate if BMI constitutes an independent prognostic factor.

Methods

We analysed all adult glioblastoma patients who underwent surgery and chemoradiotherapy between 2011 and 2017 at our institution. Overall survival was the study—primary endpoint, and progression-free survival—the secondary endpoint. We assayed age, gender, histology, extent of resection, IDH, functional and smoking status, cardiovascular risk factors, BMI, OS and PFS. Univariate analysis was conducted followed by multivariate analysis to establish independent prognostic factors. In accordance with the World Health Organization (WHO) BMI stratification, survival curves were obtained for normal-weight (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥ 30 kg/m2) patient subgroups in addition to the non-obese (18.5–29.9 kg/m2) population.

Results

193 patients were evaluated, with a median follow-up time of 17.3 months. Median OS was 21.3 months in obese patients vs 16.2 months in the non-obese (p = 0.017) and 16 months in the normal weight (p = 0.007). Higher median OS was also observed in patients under 60 and those in which GTR was obtained. Median PFS in obese individuals was 9 months in comparison to 6 months in the normal-weight subgroup (p = 0.04) and 7 months in the non-obese (p = 0.050). Multivariate analysis identified age < 60 (p = 0.044), GTR (p = 0.004) and BMI ≥ 30 (p = 0.009) as independent prognostic factors for increased overall survival.

Conclusion

Higher BMI was associated with longer OS and PFS. Prospective studies are needed to validate these findings.

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Data availability

All datasets generated for this manuscript can be obtained from the corresponding author on reasonable request.

Abbreviations

GBM:

Glioblastoma

RT:

Radiotherapy

TMZ:

Temozolomide

TTFields:

Tumour-treating fields

GTR:

Gross total removal

IDH:

Isocitrate dehydrogenase

CNS:

Central nervous system

BMI:

Body mass index

EOR:

Extent of resection

OS:

Overall survival

PFS:

Progression-free survival

CHUSJ:

Centro Hospitalar Universitário São João

WHO:

World Health Organization

MGMT:

O-6-Methylguanine-DNA methyltransferase

HGG:

Higher-grade glioma

RCC:

Renal cell cancer

CSS:

Cancer-specific survival

FASN:

Fatty acid synthase

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Authors and Affiliations

  1. Neurosurgery Department, Centro Hospitalar Universitário São João, Porto, Portugal

    Pedro Valente Aguiar, Bruno Carvalho, Rui Vaz & Paulo Linhares

  2. Faculty of Medicine, Porto University, Porto, Portugal

    Pedro Valente Aguiar, Bruno Carvalho, Rui Vaz & Paulo Linhares

  3. Neurosciences Centre, Hospital da CUF, Porto, Portugal

    Rui Vaz & Paulo Linhares

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  1. Pedro Valente Aguiar
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  2. Bruno Carvalho
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  3. Rui Vaz
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Contributions

Guarantor of integrity of the entire study: PVA. Study concepts and design: PVA and PL. Literature research: PVA and PL. Clinical studies: PVA. Experimental studies/data analysis: PVA and BDC. Statistical analysis: PVA and BDC. Manuscript preparation: PVA, PL and RV. Manuscript editing: PL and RV.

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Correspondence to Pedro Valente Aguiar.

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Valente Aguiar, P., Carvalho, B., Vaz, R. et al. Body mass index as an independent prognostic factor in glioblastoma. Cancer Causes Control 32, 327–336 (2021). https://doi.org/10.1007/s10552-020-01388-9

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  • DOI: https://doi.org/10.1007/s10552-020-01388-9

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