Abstract：
Glioblastomas with multiple foci at presentation (mGBMs) account for 2-35% of all GBMs. mGBMs have limited existing data and no standardized treatment. This study aims to determine their incidence, demographic and clinical features, outcome, and prognostic factors in terms of overall survival. We performed a monocentric retrospective study, reviewing patients treated at the Istituto Oncologico Veneto. Inclusion criteria were: new diagnosis of GBM and presence of multiple lesions on pre-treatment MRI. ECOG PS was used to evaluate clinical condition, RANO criteria for radiological assessment, and CTCAE v5.0 for treatment-related adverse events. The incidence of newly diagnosed mGBM was 7.2% and the study population consisted of 98 patients. Median age was 63 years, M:F ratio of 1.8:1, and a surgical approach was undertaken in 73 patients (mostly partial resection). MGMT was methylated in 47.5%, and 82 patients received active oncological treatment (65.9% radiotherapy plus temozolomide (RT + TMZ)). The disease control rate with RT + TMZ was 63%. Median OS of the entire study population was 10.2 months (95% CI 6.6-13.8), and median PFS was 4.2 months (95% CI 3.2-5.2). The ECOG PS, the extent of resection, and the RT + TMZ were significant prognostic factors in the univariate analysis for OS, but only the RT + TMZ was a significant independent OS predictor in the multivariate analysis (HR = 3.1, 95% IC 1.3-7.7, p = 0.014). The incidence of mGBM is not rare. RT + TMZ is confirmed to be an independent prognostic factor for survival and a safe and effective treatment. When feasible, RT + TMZ should be considered as a possible first-line treatment. The role of the extent of resection is still unclear.
摘要：
具有多个病灶的胶质母细胞瘤（mGBM）占所有GBMs.mGBM的2-35％，现有数据有限，没有标准化治疗。这项研究旨在确定它们的发病率，人口统计学和临床特征，结果,以及总体生存率方面的预后因素。我们进行了单中心回顾性研究,回顾在威尼托肿瘤学研究所接受治疗的患者。纳入标准是：GBM的新诊断和治疗前MRI上存在多个病变。ECOGPS用于评估临床状况，放射学评估的RANO标准，和CTCAEv5.0用于治疗相关的不良事件。新诊断的mGBM发生率为7.2%，研究人群为98名患者。中位年龄为63岁,M：F比为1.8：1，73例患者采用了手术方法（大部分是部分切除术）。MGMT的甲基化率为47.5%，82例患者接受了积极的肿瘤治疗(65.9%放疗加替莫唑胺(RT+TMZ)).RT+TMZ的疾病控制率为63%。整个研究人群的中位OS为10.2个月（95％CI6.6-13.8），中位PFS为4.2个月(95%CI3.2-5.2).ECOGPS,切除的程度，在OS的单因素分析中，RT+TMZ是显著的预后因素，但在多变量分析中，只有RT+TMZ是显著的独立OS预测因子(HR=3.1，95%IC1.3-7.7，p=0.014)。mGBM的发病率并不罕见。RT+TMZ被证实是生存的独立预后因素和安全有效的治疗方法。在可行的情况下,RT+TMZ应被视为可能的一线治疗。切除程度的作用尚不清楚。
