Medical comorbidities prognosticate survival in glioblastoma

Medical comorbidities are prevalent in the glioblastoma population, although their effects on survival are not well established.

We retrospectively extracted known prognostic factors and medical comorbidities at the time of glioblastoma diagnosis for 867 patients who presented to Rhode Island Hospital from 2005-2022.

All established prognostic factors were represented. Median age was 65 years (range <1-93). A higher number of comorbidities was associated with older age (p < 0.0001). Having >5 comorbidities doubled the hazard ratio compared to ≤1. While comorbidity burden correlated with decreased survival, the Charlson Comorbidity Index mainly captured the effect of age (Spearman r² = 0.874) while secondarily accounting for comorbidities. In univariate analysis, hypertension, hyperlipidemia, type 2 diabetes mellitus, atrial fibrillation, stroke, chronic obstructive pulmonary disease, and other malignancies negatively influenced survival. Multivariate analysis demonstrated that tumor resection, temozolomide/radiotherapy, O⁶-methylguanine-DNA methyltransferase methylation, and bevacizumab use were protective. Pairwise analysis identified that obesity and atrial fibrillation had a higher hazard ratio of 3.3 compared to those with either or none.

Findings from this cohort indicate that systemic metabolism plays an important role in modulating survival, and combinatorial comorbidity analysis reveals that untreated obstructive sleep apnea is a potential risk factor for worsened outcomes.