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Pseudoprogression in glioblastoma patients: the impact of extent of resection

 Hun Ho Park  ;  Tae Hoon Roh  ;  Seok Gu Kang  ;  Eui Hyun Kim  ;  Chang-Ki Hong  ;  Se Hoon Kim  ;  Sung Soo Ahn  ;  Seung Koo Lee  ;  Hye Jin Choi  ;  Jaeho Cho  ;  Sun Ho Kim  ;  Kyu-Sung Lee  ;  Chang-Ok Suh  ;  Jong Hee Chang 
 JOURNAL OF NEURO-ONCOLOGY, Vol.126(3) : 559-566, 2016 
Journal Title
Issue Date
Adult ; Aged ; Brain Neoplasms/pathology* ; Brain Neoplasms/surgery* ; Disease Progression ; Female ; Follow-Up Studies ; Glioblastoma/pathology* ; Glioblastoma/surgery* ; Humans ; Male ; Middle Aged ; Neoplasm Grading ; Neurosurgical Procedures/adverse effects* ; Postoperative Complications* ; Prognosis ; Retrospective Studies ; Survival Rate ; Young Adult
Extent of resection ; Glioblastoma ; MGMT promoter status ; Pseudoprogression
Pseudoprogression (psPD) is a radiation-induced toxicity that has substantial neurological consequence in glioblastoma (GBM) patients. MGMT promoter methylation has been shown to be an important prognostic factor of psPD, but the significance of extent of resection (EOR) remains unclear. We performed a retrospective analysis on newly diagnosed GBM patients with assessable MGMT promoter status who underwent the Stupp protocol. EOR was grouped into gross total resection (GTR), subtotal resection (STR), partial resection (PR) and stereotactic biopsy. Contrast enhancing lesion enlargement was classified as psPD or non-psPD. Among a total of 101 patients, GTR, STR, PR and stereotactic biopsy was performed in 57 (56.4%), 34 (33.7%), 9 (8.9%) and 1 patient (1%), respectively. Follow-up imaging at the end of Stupp protocol classified 45 patients (44.6%) as psPD and 56 (55.4%) as non-psPD. psPD was observed in 24 (61.5%) of 39 patients with methylated MGMT promoter and 21 (33.9%) of 62 patients with unmethylated MGMT promoter (p < 0.01). psPD was documented in 17 (29.8%), 19 (55.9%), 8 (88.9%) and 1 (100%) patient with GTR, STR, PR and stereotactic biopsy (p < 0.01), respectively. On multivariate analysis MGMT promoter status (OR 3.36, 95% CI 1.36-8.34) and EOR (OR 4.12, 95% CI 1.71-9.91) were independent predictors of psPD. A Cox proportional hazards model showed that MGMT status (HR 2.51, p < 0.01) and EOR (HR 2.99, p < 0.01) significantly influenced survival. MGMT status and EOR have a significant impact on psPD. GTR can reduce the side effects of psPD and prolong survival.
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Pathology (병리학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Seok Gu(강석구) ORCID logo https://orcid.org/0000-0001-5676-2037
Kim, Sun Ho(김선호) ORCID logo https://orcid.org/0000-0003-0970-3848
Kim, Se Hoon(김세훈) ORCID logo https://orcid.org/0000-0001-7516-7372
Kim, Eui Hyun(김의현) ORCID logo https://orcid.org/0000-0002-2523-7122
Roh, Tae Hoon(노태훈)
Park, Hun Ho(박현호) ORCID logo https://orcid.org/0000-0002-2526-9693
Suh, Chang Ok(서창옥)
Ahn, Sung Soo(안성수) ORCID logo https://orcid.org/0000-0002-0503-5558
Lee, Kyu Sung(이규성)
Lee, Seung Koo(이승구) ORCID logo https://orcid.org/0000-0001-5646-4072
Chang, Jong Hee(장종희) ORCID logo https://orcid.org/0000-0003-1509-9800
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
Choi, Hye Jin(최혜진) ORCID logo https://orcid.org/0000-0001-5917-1400
Hong, Chang Ki(홍창기) ORCID logo https://orcid.org/0000-0002-2761-0373
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