Article
Glioblastoma as a second cancer – a retrospective analysis of 2164 patients
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Published: | June 9, 2017 |
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Objective: Characterization of epidemiological, molecular and clinical features of patients being diagnosed with glioblastoma (GBM) as a second malignancy.
Methods: We utilized the cancer data management system at the Memorial Sloan Kettering Cancer Center, New York, to identify patients with a GBM diagnosis from 2007 to 2014. We collected baseline demographic, molecular and clinical data. Univariate analysis was performed to compare the cohort of GBM patients with and without prior cancer (PC) diagnosis. Survival differences were analyzed with Kaplan-Meier and log-rank testing. A Cox-proportional hazards model was fit for multivariable analysis.
Results: In total, 2164 patients harboring GBM were identified including 170 patients (7.9%) with a PC diagnosis. The median interval between diagnoses was 79 months. The most common pathologies were breast (18.8%) and prostate (18.8%) cancer followed by melanoma (10%) and lung cancer (6.5%). Only six of the PC patients had a documented history of cranial irradiation. 10% of PC patients had a history of multiple malignancies. Patients with a PC were older at the time of GBM diagnosis than those without PC (66 years vs. 59 years, p<0.001). Patients with PC were more likely to harbor an EGFR (20% vs. 12.3%, p<0.001) or MGMT mutation (17.6% vs. 11.6%, p<0.001). Adjuvant therapy regimens were similar in both cohorts with 61% (PC) and 68% (without PC) of patients having been recommended combined radiochemotherapy. Median survival was 13 months in the PC cohort and 15 months in the cohort without PC (p=not significant). Median progression free survival was 6 months (PC) and 7 months (without PC) (p=not significant). Age, KPS, and diagnosis year were the only factors which influenced outcome in multivariable analysis.
Conclusion: More patients are surviving long-term following a cancer diagnosis and as such are at risk for second malignancies. In line with this, about 8% of patients diagnosed with GBM have a history of PC. Despite significant epidemiological and molecular differences there seems to be no influence of PC on overall prognosis and clinical course.