| BackgroundGlioblastoma is the most malignant and deadly tumor in the central nerve system.Maximal tumor resection followed by concomitant radiation and chemotherapy has been the standard treatment plan,while patients' prognosis still varies one another.What determines the prognosis remains a mystery,for which heterogeneity may be responsible.Therefore,interaction effect between factors could play an important role and have significant impact on prognosis.Objectives:(1)Validation of prognostic factors that have already been found in glioblastoma.(2)Exploration and interpretation of interaction effect between factors.(3)Induction of evidence for individualized glioblastoma treatment eventually.MethodsConsecutively collected were the 66 glioblastomas treated in First Affiliated Hospital of Medical School,Zhejiang University.Patients' baseline and therapeutic as well as follow-up data were recorded.Cox proportional hazard model was used in the multi-variate analysis and interaction effect analysis.ResultsIndependent prognostic factors in overall survival of glioblastoma include frontal lobe[HR(95%CI):0.339(0.185-0.622),P<0.001;adjusted:0.186(0.059-0.586),P=0.004],total resection[HR(95%CI):0.391(0.166-0.923),P=0.032;adjusted:0.110(0.020-0.610),P=0.012],treatment after recurrence[HR(95%CI):0.321(0.118-0.871),P=0.026;adjusted:0.229(0.060-0.878),P=0.032].Independent risk factor in progression free survival of glioblastoma is frontal lobe[HR(95%CI):0.412(0.227-0.748),P=0.004;adjusted:0.382(0.172-0.850),P=0.018].Besides the network of extensive interaction between factors,treatment after recurrence,frontal lobe and preoperative KPS score had a significant cubic interaction effect(HR:0.957,95%CI:0.920-0.996,P=0.030).Conclusions:There exist correlations between variates' interaction effects and prognosis of glioblastoma,which indicates an alternative to prognose patients' postoperative survival rate,and as well suggests more individualized treatment. |
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