Frontiers in oncology · 2026
Completion of ≥6 cycles of adjuvant temozolomide is the strongest modifiable prognostic factor in glioblastoma: a 17-year real-world cohort of 319 glioma patients from a single Chinese center.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Liu Pei, Xiao Xiaotang, Hu Beiquan, Xu Kebei, Liu Ting, Liu Xu, Huang Huixian, Pang Qiang, Lu Zhiping, Qing Defeng, Liang Yu, Lin Siting, Chen Hao, Lu Heming
Аннотация
BACKGROUND: Level-1 evidence supports adjuvant temozolomide (TMZ) after chemoradiotherapy in newly diagnosed glioblastoma, but many patients discontinue before completing the six cycles the regimen calls for-particularly in China, where long-term outcome data anchored to treatment intensity remain scarce. We quantified the independent prognostic value of completing ≥6 cycles of adjuvant TMZ in a 17-year single-center Chinese glioma cohort.
METHODS: We retrospectively assembled 319 patients with pathologically confirmed glioma treated between 2009 and June 2026 at a tertiary Chinese center; 264 with complete grade, follow-up, resection, and radiotherapy data (tier A) formed the primary cohort. Overall survival (OS) was analyzed by Kaplan-Meier estimation and grade-stratified Cox regression. Robustness of the TMZ ≥6-cycle effect was probed by landmark analyses at 3, 6, 9, and 12 months; inverse-probability-of-treatment weighting (IPTW); restricted mean survival time (RMST); cause-specific Cox regression; prespecified subgroup/interaction analyses; and E-value sensitivity analysis.
RESULTS: Median follow-up was 79 months (IQR 42-115); 133 patients (50.4%) died. Five-year OS was 81.8% in WHO I-II, 42.2% in III, and 24.2% in IV (log-rank P < 0.0001). The stratified Cox model showed that ≥6 adjuvant TMZ cycles independently halved mortality (adjusted HR 0.46, 95% CI 0.31-0.67, P < 0.001), alongside age ≥60 (HR 1.97, 1.30-2.98) and radiotherapy boost/SIB (HR 1.59, 1.01-2.49). The effect held across all four landmarks (HR 0.44-0.60), after IPTW (HR 0.42, 0.29-0.62), and in the cause-specific model (HR 0.45, 0.31-0.67). RMST yielded 17.0 additional months at 5 years and 30.3 months at 10 years within WHO IV. In histologic glioblastoma, the pattern was threshold-shaped: 1-5 cycles fared no better than none (HR 0.86, P = 0.62), whereas ≥6 cycles conferred a 64% mortality reduction (HR 0.36, 0.17-0.75). E-values were 3.79 (point estimate) and 2.33 (CI limit nearer the null).
CONCLUSION: Completion of ≥6 cycles of adjuvant temozolomide was the strongest modifiable prognostic factor for OS in high-grade glioma, robust across multiple bias-mitigation frameworks, although residual confounding by unmeasured molecular subtype and baseline functional status cannot be fully excluded. Completion-not merely initiation-of adjuvant TMZ warrants explicit tracking as a quality-of-care metric.
METHODS: We retrospectively assembled 319 patients with pathologically confirmed glioma treated between 2009 and June 2026 at a tertiary Chinese center; 264 with complete grade, follow-up, resection, and radiotherapy data (tier A) formed the primary cohort. Overall survival (OS) was analyzed by Kaplan-Meier estimation and grade-stratified Cox regression. Robustness of the TMZ ≥6-cycle effect was probed by landmark analyses at 3, 6, 9, and 12 months; inverse-probability-of-treatment weighting (IPTW); restricted mean survival time (RMST); cause-specific Cox regression; prespecified subgroup/interaction analyses; and E-value sensitivity analysis.
RESULTS: Median follow-up was 79 months (IQR 42-115); 133 patients (50.4%) died. Five-year OS was 81.8% in WHO I-II, 42.2% in III, and 24.2% in IV (log-rank P < 0.0001). The stratified Cox model showed that ≥6 adjuvant TMZ cycles independently halved mortality (adjusted HR 0.46, 95% CI 0.31-0.67, P < 0.001), alongside age ≥60 (HR 1.97, 1.30-2.98) and radiotherapy boost/SIB (HR 1.59, 1.01-2.49). The effect held across all four landmarks (HR 0.44-0.60), after IPTW (HR 0.42, 0.29-0.62), and in the cause-specific model (HR 0.45, 0.31-0.67). RMST yielded 17.0 additional months at 5 years and 30.3 months at 10 years within WHO IV. In histologic glioblastoma, the pattern was threshold-shaped: 1-5 cycles fared no better than none (HR 0.86, P = 0.62), whereas ≥6 cycles conferred a 64% mortality reduction (HR 0.36, 0.17-0.75). E-values were 3.79 (point estimate) and 2.33 (CI limit nearer the null).
CONCLUSION: Completion of ≥6 cycles of adjuvant temozolomide was the strongest modifiable prognostic factor for OS in high-grade glioma, robust across multiple bias-mitigation frameworks, although residual confounding by unmeasured molecular subtype and baseline functional status cannot be fully excluded. Completion-not merely initiation-of adjuvant TMZ warrants explicit tracking as a quality-of-care metric.