Spatial and Volumetric Characteristics of Glioblastoma: Associations With Clinical Presentation and Survival

We aim to comprehensively analyze how regional tumor and edema characteristics are associated with clinical presentations and survival outcomes in a large cohort of glioblastoma patients.

Patients with IDH-wildtype glioblastoma who received brain MRI from 2010 to 2023 were included. The enhancing tumor, necrotic core, and edema/infiltration volumes were automatically segmented across brain regions. Multivariable regression assessed associations between regional volumes, presenting symptomatology, and survival outcomes.

Of 526 patients analyzed, initial presentations included seizure (29%), aphasia (26%), confusion (25%), headache (24%), focal weakness (22%), memory problems (20%), ataxia (16%), visual field deficits (11%), personality change (10%), and focal sensory abnormalities (7%). Distinct regional tumor patterns emerged: seizures were associated with smaller overall tumor burden but with relatively greater cortical involvement, headache with increased subcortical volumes, confusion with left hemisphere and temporal involvement, personality changes with frontal-cingulate-basal ganglia involvement, and focal neurologic deficits with mostly predictable patterns. While no initial presentation correlated with survival, the presence of postoperative seizures was associated with improved overall survival. Increased volume of enhancing tumor, particularly in the insula and brainstem, was associated with worse overall survival.

Anatomical tumor distribution provided prognostic information beyond overall tumor burden in glioblastoma. Regional patterns expand on the anatomical basis of symptoms. The survival benefit associated with postoperative seizures suggests distinct tumor biology or microenvironmental factors. Incorporating regional characteristics into clinical and prognostic models may improve risk stratification and inform treatment planning.