title: Survival in patients with newly diagnosed  conventional glioblastoma: a modified  prognostic score based on a single-institution series.
abstract: OBJECTIVE
  Recursive partioning analysis (RPA) is commonly used to define the stratification of patients with glioblastoma. Epigenetic silencing of the O6-methylguanine methyltransferase (MGMT) gene by promoter methylation plays an important role in regulating MGMT expression in gliomas and this is an established independent prognostic factor. We tested a prognostic scoring system including all clinical variables used by RPA classification (age, ECOG performance status and type of surgery) and MGMT gene promoter methylation status.
  
  
  METHODS
  Seventy-eight consecutive patients with newly diagnosed, histopathologically confirmed conventional glioblastoma were included. Information about MGMT promoter methylation status was available for all of them. Based on the patients' age (<50 vs ≥50 years), ECOG performance status (0 vs ≥1), type of surgery (gross tumor resection versus partial resection/biopsy) and MGMT promoter methylation status (methylated versus unmethylated), three classes of risk were generated where the prognostic score was defined assigning 1 point to every favorable parameter (Class I: ≥3; Class II: 2; Class III: 0-1). All classes were correlated with overall survival.
  
  
  RESULTS
  The median survival times were 32.4, 8.6 and 8.8 months for Class I, II and III, respectively, corresponding to 2-year survival rates of 69%, 13.5% and <1%. The same analysis was performed on 54 patients treated with postoperative concomitant chemoradiotherapy. The median survival times were 32.5, 13.4 and 8.9 months for Class I, II and III, respectively, corresponding to 2-year survival rates of 68.6%, 26.9% and <1%. In both groups of 78 and 54 patients the differences in survival between Class I and III were statistically significant ( P <0.0001).
  
  
  CONCLUSIONS
  The proposed prognostic scoring system including clinical variables and MGMT promoter methylation status proved valuable in patients with primary conventional glioblastoma, especially those treated with postoperative chemoradiotherapy.
authors: Division of Oncology, University Hospital, Via del Pozzo 71, Modena, Italy. bertolini.federica@policlinico.mo.it
authors: Federica
authors: F
authors: Bertolini
authors: Elena
authors: E
authors: Zunarelli
authors: Caterina
authors: C
authors: Baraldi
authors: Antonella
authors: A
authors: Valentini
authors: Cinzia
authors: C
authors: Del Giovane
authors: Roberta
authors: R
authors: Depenni
authors: Angelo
authors: A
authors: Falasca
authors: Patrizia
authors: P
authors: Giacobazzi
authors: Marcella
authors: M
authors: Malagoli
authors: Stefano
authors: S
authors: Meletti
authors: Annalisa
authors: A
authors: Fontana
authors: Pierfranco
authors: P
authors: Conte
mesh_terms: D016543:Central Nervous System Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000601:surgery; D059186:Chemoradiotherapy, Adjuvant; D019175:DNA Methylation; D015254:DNA Modification Methylases / Q000235:genetics / Q000378:metabolism*; D045643:DNA Repair Enzymes / Q000235:genetics / Q000378:metabolism*; D005260:Female; D015972:Gene Expression Regulation, Neoplastic; D020868:Gene Silencing; D005909:Glioblastoma / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011401:Promoter Regions, Genetic; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D025521:Tumor Suppressor Proteins / Q000235:genetics / Q000378:metabolism*
chemical_list: D025521:Tumor Suppressor Proteins; D015254:DNA Modification Methylases; C515491:MGMT protein, human; D045643:DNA Repair Enzymes