title: Prognostic paradox: brain damage around the glioblastoma resection cavity.
abstract: Hyperintense lesions around the resection cavity on magnetic resonance diffusion-weighted imaging (MR-DWI) frequently appear after brain tumor surgery due to the damage of surrounding brain. The putative connection between the lesion and the prognosis for patients with glioblastoma (GBM) was explored. This retrospective study reviewed consecutive sixty-one patients with newly diagnosed GBM. Postoperative MRI was performed within 2 weeks after the initial surgery. We classified the cases into two groups depending on whether DWI hyperintense lesions were observed or not [DWI(+) group and DWI(-) group]. Progression-free survival (PFS) and overall survival (OS) were compared between the two groups. Forty-two patients were identified. The various extents of hyperintense lesions around the resection cavity were observed in 28/42 (66.7%) cases. In the DWI(+) and DWI(-) groups, median PFS was 10.0 [95% confidence interval (CI) 8.4-11.5] and 6.7 (95% CI 4.9-8.5) months, respectively (p = 0.042), and median OS was 18.0 (95% CI 12.2-23.8) and 17.0 (95% CI 15.7-18.3) months, respectively (p = 0.254). On multivariate analysis, the presence of DWI hyperintense lesion was more likely to be an independent predictor for 6-month PFS (p = 0.019; HR, 0.038; 95% CI 0.002-0.582). Tumor recurrence appeared outside the former DWI hyperintense lesion. Hyperintense lesions surrounding the resected GBM on MR-DWI might be a favorable prognostic factor in patients with GBM.
authors.affiliation: Division of Neuroscience, Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Furuta
authors.forename: Mitsutoshi
authors.initials: M
authors.lastname: Nakada
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Ueda
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Yasuaki
authors.initials: Y
authors.lastname: Arakawa
authors.forename: Ryo
authors.initials: R
authors.lastname: Higashi
authors.forename: Masaaki
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nitta
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Jun-ichiro
authors.initials: J
authors.lastname: Hamada
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology*; D001932:Brain Neoplasms / Q000473:pathology / Q000601:surgery*; D038524:Diffusion Magnetic Resonance Imaging; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D016016:Proportional Hazards Models; D012189:Retrospective Studies