Article Figures & Data
Figures
- Fig 1.
An overview of the image-processing pipeline and model training and validation procedure to identify locations associated with survival. A, The image-processing pipeline is applied to both training (Stanford University Medical Center) and validation (TCGA) cohorts. B, Algorithm training identifies anatomic regions associated with survival, which is validated in the TCGA cohort. The training algorithm using the threshold-free cluster enhancement method takes as the input group labels dichotomized by survival outcome and the superimposed tumor heat map of the Stanford University Medical Center patient cohort analyzed in the image-processing pipeline; the pipeline outputs anatomic regions significantly associated with the 2 survival groups, which are used to classify the TCGA validation set into a poor survival group and a good survival group on the basis of tumor regions present or absent in the prognostic region.
- Fig 2.
Axial, sagittal, and coronal section views of the region associated with poor survival in the training cohort (false discovery rate, P < .05). The cluster of voxels associated with poor survival was localized in the occipitotemporal periventricular white matter in the right hemisphere (right periatrial).
- Fig 3.
Kaplan-Meier survival curves of patients with GBMs depict decreased overall survival in TCGA patients with an overlap (group I) versus nonoverlap (group II) with the voxels significantly associated with survival identified from the training cohort in the test cohort (log-rank test, P = .034).
- Fig 4.
Axial postcontrast T1-weighted images of 4 patients from group II. A, A 69-year-old man with a right parietal GBM and an overall survival of 27 months. B, A 49-year-old man with a right temporal GBM and an overall survival of 25 months. C, A 63-year-old man with a left temporal GBM and an overall survival of 21 months. D, A 36-year-old woman with a left frontal GBM, an overall survival of 6 months, and the smallest tumor volume in the group of intermediate tumors.
Tables
Survival Groups Poor (OS ≤ 11 mo) Medium (11 < OS < 17 mo) Good (OS ≥ 17 mo) Total No. 152 38 63 Median age (yr) 69.0 57.2 59.5 % Male 61.2 60.5 57.1 Median survival (mo) 4.1 14.1 21.2 Mean survival (mo) 4.8 14.0 26.3 Mean CEL volume (cm3) 34.1 34.0 28.9 STR/GTR/biopsy only (No.) 53/13/86 17/8/13 17/36/10 Note:—STR indicates subtotal resection; GTR, gross total resection.
Univariate Cox Multivariate Cox HR (95% CI) P Value HR (95% CI) P Value TCGA test cohorta Age younger than 64 yr 0.19 (0.26–0.55) 4.1e–7b 0.36 (0.24–0.53) 3.7e–7b Male sex 1.05 (0.73–1.50) .79 – – CEL tumor volume (cm3) Large 1.68 (1.10–2.54) .015b 1.80 (1.18–2.75) .0064b Intermediate – – – – Small 0.90 (0.58–1.37) .62 1.11 (0.71–1.71) .65 Right laterality 0.927 (0.65–1.32) .67 – – STR 2.52 (0.73–8.68) .14 – – Tumor location = right periatrial location 1.66 (1.03–2.67) .036b 2.0 (1.01–2.64) .045b Restricted set of intermediate and large tumorsc Age younger than 64 yr 0.19 (0.26–0.55) 4.1e–7 0.46 (0.30–0.72) .00062 Tumor location = right periatrial location 1.84 (1.10–3.08) .019 1.87 (1.11–3.15) .018 Note:—HR indicates hazard ratio; STR, subtotal resection.
↵a Age, CEL tumor volume, and tumor location were independently significant in multivariate analysis (overall P < 3.52e–8). Surgical resection is subtotal resection or gross total resection, available for 24 cases in the TCGA test cohort.
↵b P value < .05, indicating the variable is significant.
↵c Tumor location remained significant in Cox analysis performed on the restricted set of intermediate and large tumors.
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