Journal of Neuro-Oncology

, Volume 139, Issue 1, pp 125–133 | Cite as

Multi-center study finds postoperative residual non-enhancing component of glioblastoma as a new determinant of patient outcome

  • Aikaterini Kotrotsou
  • Ahmed Elakkad
  • Jia Sun
  • Ginu A. Thomas
  • Dongni Yang
  • Srishti Abrol
  • Wei Wei
  • Jeffrey S. Weinberg
  • Ali S. Bakhtiari
  • Moritz F. Kircher
  • Markus M. Luedi
  • John F. de Groot
  • Raymond Sawaya
  • Ashok J. Kumar
  • Pascal O. Zinn
  • Rivka R. Colen
Clinical Study



The aim of the present study is to assess whether postoperative residual non-enhancing volume (PRNV) is correlated and predictive of overall survival (OS) in glioblastoma (GBM) patients.


We retrospectively analyzed a total 134 GBM patients obtained from The University of Texas MD Anderson Cancer Center (training cohort, n = 97) and The Cancer Genome Atlas (validation cohort, n = 37). All patients had undergone postoperative magnetic resonance imaging immediately after surgery. We evaluated the survival outcomes with regard to PRNV. The role of possible prognostic factors that may affect survival after resection, including age, sex, preoperative Karnofsky performance status, postoperative nodular enhancement, surgically induced enhancement, and postoperative necrosis, was investigated using univariate and multivariate Cox proportional hazards regression analyses. Additionally, a recursive partitioning analysis (RPA) was used to identify prognostic groups.


Our analyses revealed that a high PRNV (HR 1.051; p-corrected = 0.046) and old age (HR 1.031; p-corrected = 0.006) were independent predictors of overall survival. This trend was also observed in the validation cohort (higher PRNV: HR 1.127, p-corrected  = 0.002; older age: HR 1.034, p-corrected  = 0.022). RPA analysis identified two prognostic risk groups: low-risk group (PRNV < 70.2 cm3; n = 55) and high-risk group (PRNV ≥ 70.2 cm3; n = 42). GBM patients with low PRNV had a significant survival benefit (5.6 months; p = 0.0037).


Our results demonstrate that high PRNV is associated with poor OS. Such results could be of great importance in a clinical setting, particularly in the postoperative management and monitoring of therapy.


Glioblastoma Survival Postoperative Invasion 



We thank The Cancer Genome Atlas and The Cancer Imaging Archive initiatives for making the clinical and imaging data publicly available. This research was partially funded by the John S. Dunn Sr. Distinguished Chair in Diagnostic Imaging Fund, MD Anderson Brain Tumor Center Program, MD Anderson Cancer Center startup funding, and the Cancer Prevention and Research Institute of Texas Individual Investigator Research Award (RP160150).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Aikaterini Kotrotsou
    • 1
    • 8
  • Ahmed Elakkad
    • 1
  • Jia Sun
    • 2
  • Ginu A. Thomas
    • 1
  • Dongni Yang
    • 3
  • Srishti Abrol
    • 1
  • Wei Wei
    • 2
  • Jeffrey S. Weinberg
    • 4
  • Ali S. Bakhtiari
    • 1
  • Moritz F. Kircher
    • 5
  • Markus M. Luedi
    • 1
    • 9
  • John F. de Groot
    • 6
  • Raymond Sawaya
    • 4
  • Ashok J. Kumar
    • 1
  • Pascal O. Zinn
    • 4
    • 7
    • 10
  • Rivka R. Colen
    • 1
    • 8
  1. 1.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of BiostatisticsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.Department of Diagnostic Interventional and ImagingThe University of Texas Health Science CenterHoustonUSA
  4. 4.Department of NeurosurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  6. 6.Department of Neuro-OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  7. 7.Department of NeurosurgeryBaylor College of MedicineHoustonUSA
  8. 8.Department of Cancer Systems ImagingThe University of Texas MD Anderson Cancer CenterHoustonUSA
  9. 9.Department of Anesthesiology, Bern University Hospital InselspitalUniversity of BernBernSwitzerland
  10. 10.Department of Cancer Biology, Division of Basic Science ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA

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