| Purpose: To analyze the clinical factors affecting the prognosis of patients with high-grade glioma and to explore novel prognostic-related biomarkers for high-grade glioma(HGG);to compare the dosimetric differences between different target areas delineation in HGG based on two target areas delineation principles,European Organization for Research and Treatment of Cancer(EORTC)and NRG consensus published in 2019(NRG-2019),with the aim of providing a theoretical basis for the application of the NRG-2019 target areas delineation consensus and further improving the outcome of patients with high-grade glioma.Materials and methods:1)A retrospective analysis of 152 newly diagnosed high-grade glioma patients from november 2016 to april 2020 at the Affiliated Cancer Hospital of Xiangya School of Medicine,Central South University/ Hunan Cancer Hospital,China.Clinical data such as age,gender,tissue type,mean temporalis muscle thickness(TMT),isocitrate dehydrogenase(IDH)status,World Health Organization(WHO)classification,karnofsky performance status(KPS)score,extent of surgical resection,preoperative neutrophil count,preoperative platelet count,preoperative lymphocyte count,albumin-to-globulin ratio(AGR),red blood cell distribution width(RDW),prognostic nutrition index(PNI),lymphocyte to monocyte ratio(LMR),systemic inflammation response index(SIRI),neutrophil-to-lymphocyte ratio(LMR),neutrophil-tolymphocyte ratio(NLR),platelet-to-lymphocyte ratio(PLR),lymphocyte-to-monocyte ratio(LMR),radiotherapy status,date of diagnosis and date of death or last death.Statistical analysis was performed using SPSS version 24.0 software.The primary observed endpoint was overall survival(OS)and the secondary observed endpoint was progression free survival(PFS).Demographic and clinical characteristics were summarised by descriptive and frequency statistics.Univariate and multivariate Cox regression analyses were performed to assess independent prognostic parameters,Kaplan-Meier method for survival analysis and plotting of survival curves;2)In 13 cases,two treatment plans were designed for each patient according to two different target area delineation guidelines,NRG-2019 and EORTC,and the dosimetric parameters of the planned target areas were compared between the two groups.Dosimetric parameters were collected for 26 treatment plans in the NRG-2019 and EORTC groups in13 patients according to the Dose-Volume Histogram(DVH)of the target area,such as: conformity Index(CI),homogeneity Index(HI),D95%,D98%,D2%,D50%,D5%(Dx% represents x% of the dose received to the target volume),V30,V46,V60(the ratio of the volume of the brain receiving 30 Gy,46Gy and 60 Gy doses)for the whole brain,Dmean,Dmax and Dmin for the brainstem,left/right optic nerve,optic chiasm,left/right eye,left/right crystal and healthy temporal lobe,etc.Rank sum test was used to compare the dosimetric differences between the treatment plans formed by these two different outlining methods in 13 patients.P-values < 0.05 were considered statistically significant.Results:1)The median follow-up of 152 patients was 16.5 months(2-61months),with 1-year,2-year and 3-year OS of 57.9%,32.6% and 16.6%,respectively;and 1-year,2-year and 3-year PFS of 50.7%,22.8% and11.1%,respectively.2)Univariate COX analysis revealed that age,whether the lesion was solitary,WHO classification,mean temporalis muscle thickness,surgical extent of resection,tumor length,preoperative epilepsy or not,preoperative KPS score,IDH1 status,radiotherapy status,preoperative neutrophil count,preoperative platelet count,preoperative lymphocyte count,RDW,PNI,LMR,SIRI,NLR,PLR were associated with OS in HGG.COX multifactorial analysis showed that patients with WHO grade IV(HR= 1.748,P= 0.018),IDH1 wild type(HR= 2.199,P= 0.007),no radiotherapy(HR= 24.121,P= 0.000),and NLR value >2.44(HR= 2.188,P= 0.030)were independent risk factors for OS.Mean TMT >7.05 mm(HR= 0.485,P= 0.006)and preoperative KPS score >70(HR= 0.598,P=0.026)were independent protective factors for OS.3)COX univariate analysis showed that whether the lesion was solitary,WHO classification,mean TMT,extent of surgical resection,tumor length,preoperative epilepsy or not,preoperative KPS score,IDH1 status,radiotherapy status,preoperative lymphocyte level,PNI,preoperative neutrophils,SIRI,RDW,NLR,PLR,LMR were factors influencing the prognosis of PFS in high-grade glioma.COX multifactorial analysis showed that patients WHO grade IV(HR= 1.595,P= 0.032),IDH1 wild type(HR= 1.879,P= 0.024),no radiotherapy(HR= 11.515,P= 0.000),and tumor length diameter ≥5 cm(HR= 1.484,P= 0.043)were independent risk factors for postoperative PFS in highgrade glioma factors.4)the dose distribution of the 26 plans in both groups met the prescribed dose requirements for the target area in 13 patients in this study,and the conformability of the target area and the dose uniformity within the target area were good.Dmean,Dmax and Dmin of the whole brain,brainstem,left/right optic nerve,optic cross,left/right eye,left/right crystal and temporal lobe were not significantly different between the two target areas(P > 0.05).There were no significant differences in V30,V46 and V60 of brain volumes(P > 0.05).Conclusions:1)HGG with WHO grade IV,IDH1 wild type,no radiotherapy,and NLR value greater than 2.44 had a poor prognosis;HGG with mean TMT greater than 7.05 mm and preoperative KPS score greater than 70 had a good prognosis;2)WHO grade IV,IDH1 wild type,no radiotherapy and tumor length diameter greater than or equal to 5 cm were risk factors for PFS of HGG;3)NRG-2019 consensus could delineate the edema region of HGG into CTV without increasing the irradiated dose of OARs compared with EORTC postoperative radiotherapy consensus. |
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