Literature compilation | temporal muscle thickness is the prognosis of patients with newly diagnosed glioblastoma indicators: based on the subsequent analysis of the latest clinical trials
Union Journal of Neurooncologyhttps://clincancerres.aacrjournals.org/content/early/2021/10/18/1078-0432.CCR-21-1987 glioblastoma is the highest of the central nervous system in the malignant degree of primary tumor,The 5-year survival rate is less than 5%.At the same time, most patients experienced tumor recurrence within 1 year, despite a combination of neurosurgical intervention and chemoradiotherapy with temozolomide.In the era of personalized medicine, stratified management of glioblastoma patients according to a variety of proven parameters is associated with prognosis, including:Patients with age, physiological status, tumor size, location, histopathological and molecular pathological characteristics, and so on, which also has a doctor’s subjective evaluation with objective testing indicators, such as the physiological state of the patients, subjective evaluation is vulnerable to assess their own influence and variation is larger, so by looking for objective and measurable indicators to evaluate patients condition can improve the accuracy of the prognostic judgment.At present, skeletal muscle mass measurement is increasingly widely used in clinical assessment of patients’ physiological status, usually by measuring the skeletal muscle cross-sectional area at the level of the third lumbar spine.For patients with brain tumors, abdominal CT is not a routine imaging examination, so it is not feasible to judge the nutritional status of patients by the skeletal muscle area of the lumbar spine.Recent studies have shown that Temporal muscle thickness (TMT) measured by head MRI is highly correlated with the skeletal muscle cross-sectional area at the level of the third lumbar spine, which can also be used to judge the skeletal muscle level and overall nutritional status.Professor Julia Furtner from the Department of Biomedical Imaging and Image-guided Therapy at the Medical University of Vienna,Temporal Muscle Thickness is an Independent Prognostic Marker in patients with progressive Disease, Neuro-Oncology, August 2019glioblastoma: Translational imaging analysis of the EORTC 26101 Trial in Translational Imaging analysis of the EORTC 26101 Trial in Translational Imaging analysis of the EORTC 26101 TrialFurtner also presented a follow-up analysis of CENTRIC EORTC 26071-22072, a phase III Clinical trial, and CORE, a Phase II Clinical trial, published in Clinical Cancer Research on October 19, 2021.The corresponding author is Professor Matthias Preusser, Faculty of Medicine, Medical University of Vienna.This study explored the prognostic role of gender-specific TMT thresholds in determining the risk of progressive saropenia in patients with newly diagnosed glioblastoma (MGMT promoter methylated or non-methylated).The prognosis of glioblastoma is poor due to its high degree of malignancy, rapid progression and high recurrence rate.In clinical practice, in addition to exploring more effective treatment methods, building a reliable prognostic model based on some parameters is also important for doctors to formulate treatment strategies for patients, which is also the development direction of personalized therapy in the future.In 2019, the authors published a study on the correlation between mean temporal muscle thickness (TMT) and prognostic indicators (OS and PFS) in patients with progressive glioblastoma:Data from all 260 patients enrolled in the Phase II clinical trial of the EORTC 26101 study were included as a training set. According to OS and PFS, the optimal cut-off point of TMT was determined. Higher than the cut-off point was considered as the high level of TMT, and lower than the cut-off point was considered as the low level of TMT.Data from all 308 patients enrolled in the phase III trial of the same study were included as a test set, and statistically demonstrated that higher TMT levels were associated with better outcomes.On this basis, this study turned to a new diagnosis of glioblastoma, further supplementing the good correlation between skeletal muscle state substitution parameters and prognosis of such patients:Participants in the EORTC 26071-22072 phase III and CORE Phase II trials were defined as “at risk for muscle loss” at baseline TMT values (mean TMT in the healthy reference population minus 2.5 sd) based on gender.Otherwise, patients with “normal muscle status” had a statistically worse prognosis than those with “risk of muscle loss”.The two studies used different methods to define TMT levels in patients with advanced and newly diagnosed rGBM respectively, but the two conclusions were consistent, namely, low TMT levels in patients with glioblastoma were associated with poor prognosis.Methods TMT was measured based on axial isotropic T1-enhanced MRI by an experienced radiologist who had no knowledge of the clinical information of all patients, and the final TMT value was the average TMT of the left and right sides.Intervention that may affect the temporal muscle thickness on one side (unilateral edema or muscle atrophy) was only included in the contralateral TMT; if the temporal muscle thickness was affected on both sides, the patient was excluded.A total of 755 patients were enrolled at the EORTC 26071-22072(n=508) from phase III and CORE(n=247) from Phase II. On the one hand, baseline TMT values at the time of disease diagnosis were compared with pre-determined gender-specific TMT thresholds.Divided into “patients at risk of muscle loss” (TMT below the threshold) and “patients with normal muscle condition” (TMT above the threshold);On the other hand, the most recent TMT value (before death or loss of follow-up) and the reduction of baseline TMT were calculated, and the patients were divided into “relTMT=100%” (no TMT change), “relTMT=99-90%” (TMT slightly decreased), and “relTMT study Results (I) The relationship between baseline TMT value and prognosis:Among glioblastoma patients newly diagnosed with MGMT methylated (CENTRIC cohort) and non-methylated (CORE cohort), the mean baseline TMT was 6.7mm (SD was 1.6mm);The TMT value of male patients was significantly higher than that of female patients (in CENTRIC cohort: 7.2mm VS 6.2mm;In CORE cohort: 7.1mm VS 6.1mm);However, mean TMT values were not associated with steroid use or whether MGMT methylation occurred.Kaplan-meier curves of OS (A) and PFS (B).Patients with “at risk for muscle loss” (below the sex-specific TMT threshold, represented by the black line) and “patients with normal muscle condition” (above the sex-specific TMT threshold, represented by the gray line) had higher OS (figure A) and PFS (figure B).(II) The relationship between TMT changes and prognosis With the progression of the disease, TMT value decreased in about 60% of patients, especially in patients with normal muscle status.However, there was no significant correlation between the degree of muscle loss and OS in patients with normal muscle status (CENTRIC: P =0.166;CORE: P =0.082) versus those at risk of muscle loss (CENTRIC: P =0.425 CORE: P =0.499).According to the degree of TMT reduction (black line: relTMT=100%;Dark grey: relTMT 90 — 99%;Following the authors’ 2019 report that TMT has a strong prognostic value for glioblastomas that progress after standard first-line therapy, we demonstrate that this conclusion is also applicable to patients with newly diagnosed glioblastomas.TMT has been shown to be useful in predicting the prognostic status of brain metastases in melanoma, non-small cell lung cancer and breast cancer, and can improve clinical decision making and patient stratification in clinical trials by complementing scores showing muscle loss and other prognostic factors.This author Peking union medical college hospital neurosurgery, Peking union medical college grade 2016 eight-year program of clinical medicine doctor Xia Yu current editor of doctor of vice director of the Peking union medical college hospital neurosurgery Wang Yu Associate professor, md, a postdoctoral fellow to stay in the United States the Peking union medical college hospital neurosurgery malignant tumor experts visit time: ulquiorra chief physician The special consultation clinic on Thursday morning.Wang Yu, deputy chief physician, special clinic on Thursday afternoon.(It is recommended that patients who want to consult treatment plan or participate in clinical trial should choose the above outpatient time for face-to-face consultation.)Union Neurooncology Weekly is jointly compiled and produced by the Neurosurgery Department of Peking Union Medical College Hospital and shenwaifrontier new media, reporting the latest advances in this field. 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