Background: Aberrant vascular architecture and angiogenesis are hallmarks of glioblastoma IDH-wildtype, suggesting that these tumors are suitable for antiangiogenic therapy. Bevacizumab was FDA-approved in 2009 following promising results in two clinical trials. However, its use for recurrent glioblastomas remains a subject of debate, as it does not universally improve patient survival. Purposes: In this study, we aimed to analyze the influence of tumor vascularity on the benefit provided by BVZ and propose preoperative rCBVmax at the high angiogenic tumor habitat as a predictive biomarker to select patients who can benefit the most. Methods: Clinical and MRI data from 106 patients with glioblastoma IDH-wildtype have been analyzed. Thirty-nine of them received BVZ, and the remaining sixty-seven did not receive a second-line treatment. The ONCOhabitats method was used to automatically calculate rCBV. Results: We found a median survival from progression of 305 days longer for patients with moderate vascular tumors who received BVZ than those who did not receive any second-line treatment. This contrasts with patients with high-vascular tumors who only presented a median survival of 173 days longer when receiving BVZ. Furthermore, better responses to BVZ were found for the moderate-vascular group with a higher proportion of patients alive at 6, 12, 18, and 24 months after progression. Conclusions: We propose rCBVmax as a potential biomarker to select patients who can benefit more from BVZ after tumor progression. In addition, we propose a threshold of 7.5 to stratify patients into moderate- and high-vascular groups to select the optimal second-line treatment.
背景：异常血管结构和血管生成是IDH野生型胶质母细胞瘤的显著特征，表明这类肿瘤适合抗血管生成治疗。基于两项临床试验的积极结果，贝伐珠单抗于2009年获美国食品药品监督管理局批准。然而，其在复发性胶质母细胞瘤中的应用仍存争议，因其并非普遍改善患者生存期。目的：本研究旨在分析肿瘤血管化程度对贝伐珠单抗疗效的影响，并提出将高血管生成肿瘤区域的术前最大相对脑血容量作为预测性生物标志物，以筛选可能获益最大的患者群体。方法：研究分析了106例IDH野生型胶质母细胞瘤患者的临床及磁共振成像数据。其中39例接受贝伐珠单抗治疗，其余67例未接受二线治疗。采用ONCOhabitats方法自动计算相对脑血容量。结果：研究发现，接受贝伐珠单抗治疗的中度血管化肿瘤患者，其进展后中位生存期较未接受二线治疗者延长305天。而高度血管化肿瘤患者接受贝伐珠单抗治疗后，中位生存期仅延长173天。此外，中度血管化组对贝伐珠单抗的治疗反应更佳，在疾病进展后6、12、18及24个月时存活患者比例更高。结论：我们提出将最大相对脑血容量作为潜在生物标志物，用于筛选肿瘤进展后可能从贝伐珠单抗治疗中获益更大的患者。同时建议以7.5为阈值将患者分为中度与高度血管化组，以指导最佳二线治疗方案的选择。
肿瘤(癌症)患者之家