Image-based Re-evaluation of the JCOG0911 Study Focusing on Tumor Volume and Survival, Disease Progression Diagnosis, and Radiomic Prognostication for Newly Diagnosed Glioblastoma

• Published in: Magnetic Resonance in Medical Sciences 2024, pp.mp.2024-0103
• Main Authors: Kinoshita, Manabu, Fushimi, Yasutaka, Masumoto, Tomohiko, Sasaki, Keita, Sekita, Tetsuya, Natsume, Atsushi, Wakabashi, Toshihiko, Komori, Takashi, Tsuzuki, Shunsuke, Muragaki, Yoshihiro, Motomura, Kazuya, Saito, Ryuta, Sato, Kenichi, Beppu, Takaaki, Takahashi, Masamichi, Kuroda, Jun-Ichiro, Sonoda, Yukihiko, Kobayashi, Keiichi, Mishima, Kazuhiko, Mitsuya, Koichi, Yamasaki, Fumiyuki, Inoue, Akihiro, Matsutani, Tomoo, Nakamura, Hideo, Yamaguchi, Shigeru, Ishikawa, Eiichi, Nakaya, Masato, Tanaka, Shota, Ujifuku, Kenta, Uchida, Hiroyuki, Kanamori, Masayuki, Otani, Ryohei, Kijima, Noriyuki, Nishida, Namiko, Yoshino, Atsuo, Mineharu, Yohei, Arakawa, Yoshiki, Fukuda, Haruhiko, Narita, Yoshitaka, Members of Japan Clinical Oncology Group Brain Tumor Study Group (JCOG-BTSG)
• Format: Article
• Language: English
• Subjects: glioblastoma; progression-free survival; radiomics; RANO; RECIST
• ISSN: 1347-3182; 1880-2206
• DOI: 10.2463/mrms.mp.2024-0103

Purpose: To re-evaluate images recovered from JCOG0911, a randomized phase 2 trial for newly diagnosed glioblastoma (nGBM) conducted by the Japan Clinical Oncology Group (JCOG) Brain Tumor Study Group.Methods: The correlation between tumor volumes and survival was evaluated, followed by progression-free survival (PFS) analysis by independent central review based on Response Assessment in Neuro-Oncology (RANO) criteria using MRI recovered from 118 nGBM patients enrolled in the JCOG0911 trial. A radiomic analysis was also performed to identify radiomic features predictive of nGBM prognosis.Results: The distribution of the Gd-enhancing and T2-weighted image/fluid attenuated inversion recovery-high intensity lesions mainly occupied white matter. JCOG0911 consisted of more subjects with right-sided lesions. The median extent of resection of the Gd-enhancing lesions was 99%. The overall survival showed a nonsignificant negative trend with postoperative Gd-enhancing lesion volume (P = 0.22), with the hazard ratio increasing in parallel with its volume. The median PFS after registration was 302 and 308 days for local Response Evaluation Criteria in Solid Tumors (RECIST)-based and central RANO-based diagnoses. However, an apparent discrepancy was observed between the two in the early phase, presumably due to the misdiagnosis of pseudoprogression by local RECIST-based diagnosis. Radiomic analysis identified 28 radiomic features predictive of nGBM prognosis, 5 of which were those previously identified in a separate cohort. The constructed radiomics-based prognostic model stratified the cohort into high- and low-risk groups (P = 0.028).Conclusion: Novel analytical methods that could be incorporated into future clinical trials were successfully tested. RANO and RECIST may not differ in progression calls if pseudoprogression is appropriately handled.