Nomogram Model for Predicting the Prognosis of High-Grade Glioma in Adults Receiving Standard Treatment: A Retrospective Cohort Study

Objectives: To identify the critical factors associated with the progression-free survival (PFS) and overall survival (OS) of high-grade glioma (HGG) in adults who have received standard treatment and establish a novel graphical nomogram and an online dynamic nomogram. Patients and Methods: This is a retrospective study of adult HGG patients receiving standard treatment (surgery, postoperative radiotherapy, and temozolomide (TMZ) chemotherapy) at Huashan Hospital, Fudan University between January 2017 and December 2019. We used uni- and multi-variable COX models to identify the significant prognostic factors for PFS and OS. Based on the significant predictors, graphical and online nomograms were established. Results: A total of 246 patients were enrolled in the study based on the inclusion criteria. The average PFS and OS were 22.99 +/- 11.43 and 30.51 +/- 13.73 months, respectively. According to the multi-variable COX model, age, extent of resection (EOR), and IDH mutation were associated with PFS and OS, while edema index (EI) was relevant to PFS. In addition, patients with IDH and TERT promoter co-mutations had longer PFSs and OSs, and no apparent survival benefit was found in the long-cycle TMZ adjuvant chemotherapy compared with the standard Stupp protocol. Based on these critical factors, a graphical nomogram and online nomogram were developed for predicting PFS and OS, respectively. The calibration curve showed favorable consistency between the predicted and actual survival rates. C-index and time-dependent AUC showed good discrimination abilities. Conclusions: We identified the significant predictors for the PFS and OS of HGG adults receiving standard treatment and established user-friendly nomogram models to assist neurosurgeons in optimizing clinical management and treatment strategies.

Automated summary

This study aimed to identify critical factors associated with progression-free survival (PFS) and overall survival (OS) in adult patients with high-grade glioma (HGG) who received standard treatment, and to establish a novel graphical nomogram and online dynamic nomogram. Factors including age, extent of resection (EOR), IDH mutation, and edema index (EI) were found to be associated with PFS and OS. Additionally, patients with IDH and TERT promoter co-mutations had longer PFS and OS. Nomogram models were developed based on these factors to assist in clinical management and treatment strategies.