Low white matter tract density associated with longer Overall survival in patients with Glioblastoma

A recent study published in the Journal of American Medical Association suggests that the prognosis for patients with glioblastoma (GBM) may be linked to the structural connectivity of their brains. Alessandro Salvalaggio and team have introduced a novel measure called the tract density index (TDI), shedding new light on how the organization of white matter tracts affected by GBM can impact a patient's overall survival (OS).

This significant research, a collaboration between medical teams in Italy and Germany, analyzed data from two cohorts of GBM patients. The discovery cohort consisted of 112 patients who underwent surgery between February 1, 2015, and November 30, 2020, in Italy. A replicative cohort of 70 patients, who had surgery between September 1, 2012, and November 30, 2015, in Germany, further validated the findings.

The study, which followed patients until May 31, 2023, revealed that the TDI was significantly correlated with OS in both cohorts. Notably, the TDI's association with survival was found to be more robust compared to other established prognostic factors, such as age, performance status, O6-methylguanine-DNA methyltransferase methylation, and extent of surgery.

In the discovery cohort, the TDI demonstrated a clear correlation with OS, showcasing its potential as a valuable predictive tool. The TDI displayed a significant regression pattern and effectively stratified patients into groups with lower or higher OS based on the index. These results were consistently confirmed in the replicative cohort.

What makes this discovery particularly noteworthy is the implication that GBMs within regions of the brain with lower white matter tract density are associated with longer OS. This innovative approach to assessing brain connectivity could revolutionize the way clinicians predict outcomes for GBM patients. It may become a vital component in clinical trials and medical practice, allowing for more tailored treatments based on an individual's unique brain organization.

These findings not only contribute to our understanding of glioblastoma but also underscore the importance of considering the brain's structural connectivity when assessing patient outcomes. Further studies and clinical trials are likely to follow, aiming to harness the potential of the TDI to benefit GBM patients worldwide.

Reference:

Salvalaggio, A., Pini, L., Gaiola, M., Velco, A., Sansone, G., Anglani, M., Fekonja, L., Chioffi, F., Picht, T., Thiebaut de Schotten, M., Zagonel, V., Lombardi, G., D’Avella, D., & Corbetta, M. (2023). White Matter Tract Density Index Prediction Model of Overall Survival in Glioblastoma. In JAMA Neurology. American Medical Association (AMA). https://doi.org/10.1001/jamaneurol.2023.3284