title: Enhancing tumor apparent diffusion coefficient histogram skewness stratifies the postoperative survival in recurrent glioblastoma multiforme patients undergoing salvage surgery.
abstract: Objective To determine the value of apparent diffusion coefficient (ADC) histogram parameters for the prediction of individual survival in patients undergoing surgery for recurrent glioblastoma (GBM) in a retrospective cohort study. Methods Thirty-one patients who underwent surgery for first recurrence of a known GBM between 2008 and 2012 were included. The following parameters were collected: age, sex, enhancing tumor size, mean ADC, median ADC, ADC skewness, ADC kurtosis and fifth percentile of the ADC histogram, initial progression free survival (PFS), extent of second resection and further adjuvant treatment. The association of these parameters with survival and PFS after second surgery was analyzed using log-rank test and Cox regression. Results Using log-rank test, ADC histogram skewness of the enhancing tumor was significantly associated with both survival (p = 0.001) and PFS after second surgery (p = 0.005). Further parameters associated with prolonged survival after second surgery were: gross total resection at second surgery (p = 0.026), tumor size (0.040) and third surgery (p = 0.003). In the multivariate Cox analysis, ADC histogram skewness was shown to be an independent prognostic factor for survival after second surgery. Conclusion ADC histogram skewness of the enhancing lesion, enhancing lesion size, third surgery, as well as gross total resection have been shown to be associated with survival following the second surgery. ADC histogram skewness was an independent prognostic factor for survival in the multivariate analysis.
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany. amirzolal@gmail.com.
authors.forename: Amir
authors.identifier: http://orcid.org/0000-0003-3729-2513
authors.initials: A
authors.lastname: Zolal
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Tareq A
authors.initials: TA
authors.lastname: Juratli
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Linn
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Dino
authors.initials: D
authors.lastname: Podlesek
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Kerim Hakan
authors.initials: KH
authors.lastname: Sitoci Ficici
authors.affiliation: Institute for Diagnostic and Interventional Neuroradiology, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Hagen H
authors.initials: HH
authors.lastname: Kitzler
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schackert
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Stephan B
authors.initials: SB
authors.lastname: Sobottka
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Rieger
authors.affiliation: Department of Neurosurgery, Carl Gustav Carus Faculty of Medicine, Dresden University of Technology, Fetscherstrasse 74, 01307, Dresden, Germany.
authors.forename: Dietmar
authors.initials: D
authors.lastname: Krex
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D055815:Young Adult
keywords: Diffusion magnetic resonance imaging; Glioblastoma multiforme; Local neoplasm recurrence; Radiation effects; Survival
references.citation: Neurosurgery. 1998 Apr;42(4):709-20; discussion 720-3
references.pmid: 9574634
references.citation: Neuroimage. 2002 Oct;17(2):825-41
references.pmid: 12377157
references.citation: Radiology. 2009 Jul;252(1):182-9
references.pmid: 19561256
references.citation: J Neurooncol. 2015 May;123(1):179-88
references.pmid: 25894597
references.citation: AJNR Am J Neuroradiol. 2011 May;32(5):882-9
references.pmid: 21330401
references.citation: NMR Biomed. 2015 Apr;28(4):468-85
references.pmid: 25802212
references.citation: Br J Neurosurg. 2008 Jun;22(3):452-5
references.pmid: 18568742
references.citation: J Neurooncol. 2000 Dec;50(3):215-26
references.pmid: 11263501
references.citation: Neuroradiology. 2011 Apr;53(4):291-302
references.pmid: 21125399
references.citation: AJNR Am J Neuroradiol. 2005 Jun-Jul;26(6):1455-60
references.pmid: 15956515
references.citation: IEEE Trans Med Imaging. 2001 Jan;20(1):45-57
references.pmid: 11293691
references.citation: Med Image Anal. 2008 Feb;12(1):26-41
references.pmid: 17659998
references.citation: PLoS One. 2014 Sep 30;9(9):e108335
references.pmid: 25268588
references.citation: J Clin Oncol. 1999 Aug;17(8):2572-8
references.pmid: 10561324
references.citation: J Neurosurg. 2013 Apr;118(4):812-20
references.pmid: 23082884
references.citation: Hum Brain Mapp. 2002 Nov;17(3):143-55
references.pmid: 12391568
references.citation: J Neurooncol. 2015 Jan;121(2):331-9
references.pmid: 25351579
references.citation: Neuro Oncol. 2012 Jul;14(7):919-30
references.pmid: 22561797
references.citation: Radiology. 2014 Apr;271(1):200-10
references.pmid: 24475840
references.citation: N Engl J Med. 2005 Mar 10;352(10 ):987-96
references.pmid: 15758009
references.citation: J Neurooncol. 2014 Apr;117(2):365-72
references.pmid: 24535317
references.citation: AJNR Am J Neuroradiol. 2001 Jan;22(1):60-4
references.pmid: 11158889