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Peer-reviewedCC BYJournal of clinical medicine

Early Mortality in Patients with Biopsy-Only Glioblastoma: Clinical, Radiological and Molecular Predictors from a Retrospective Cohort

  • Massimiliano Domenico Rizzaro1,2
  • Giulio Bertani2
  • Claudia Fanizzi2
  • Luigi Gianmaria Remore1,2
  • Luigi Schisano2
  • Stefano Borsa2
  • Giorgio Fiore2
  • Guido Del Vecchio3
  • Jacopo Ascani1,2
  • Elena Scagliotti2
  • Manuela Caroli2
  • Marco Locatelli1,2
  1. 1Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
  2. 2Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
  3. 3Neuroradiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
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Abstract

Background/Objectives: Patients with unresectable glioblastoma (GBM) undergoing biopsy alone represent a clinically heterogeneous population with poor survival and limited access to standard oncological treatment. We investigated clinical, radiological, and histomolecular factors associated with early mortality after biopsy. Methods: We retrospectively analyzed 93 consecutive cases of patients with IDH-wildtype GBM who underwent biopsy without tumor resection between 2013 and 2025. Early death was defined as death within three months of biopsy. Baseline clinical, radiological, and molecular variables were evaluated using univariable analyses and exploratory multivariable logistic regression. Results: Median overall survival was 3 months, and 48/89 patients with available survival data (53.9%) died within three months. Preoperative Karnofsky Performance Status (KPS) and MGMT promoter methylation status (available for 71/93 patients) were nominally associated with early mortality in univariable analyses, although these associations did not remain significant after FDR correction. Age was not significant in univariable analysis but was associated with early mortality after adjustment in the exploratory multivariable model based on 62 complete cases. Conventional radiological parameters showed no consistent association with early death. Exploratory analysis suggested a high-risk phenotype combining KPS ≤ 60 and FLAIR signal crossing the midline. Overall, 23/93 patients (24.7%) did not initiate any adjuvant treatment, while only 17/93 (18.3%) completed the Stupp regimen. Conclusions: Early mortality is frequent in biopsy-only GBM. Clinical and molecular factors may help identify particularly vulnerable patients at diagnosis, supporting individualized treatment planning and shared decision-making. External validation in larger multicenter cohorts is warranted.

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Cite

BibTeXRIS
BibTeX
@article{rizzaro2026early,
  title = {{Early Mortality in Patients with Biopsy-Only Glioblastoma: Clinical, Radiological and Molecular Predictors from a Retrospective Cohort}},
  author = {Massimiliano Domenico Rizzaro and Giulio Bertani and Claudia Fanizzi and Luigi Gianmaria Remore and Luigi Schisano and Stefano Borsa and Giorgio Fiore and Guido Del Vecchio and Jacopo Ascani and Elena Scagliotti and Manuela Caroli and Marco Locatelli},
  journal = {Journal of clinical medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15197639},
  url = {https://europepmc.org/article/PMC/PMC13666172},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Early Mortality in Patients with Biopsy-Only Glioblastoma: Clinical, Radiological and Molecular Predictors from a Retrospective Cohort
AU  - Massimiliano Domenico Rizzaro
AU  - Giulio Bertani
AU  - Claudia Fanizzi
AU  - Luigi Gianmaria Remore
AU  - Luigi Schisano
AU  - Stefano Borsa
AU  - Giorgio Fiore
AU  - Guido Del Vecchio
AU  - Jacopo Ascani
AU  - Elena Scagliotti
AU  - Manuela Caroli
AU  - Marco Locatelli
PY  - 2026
DA  - 2026/10/01
JO  - Journal of clinical medicine
DO  - 10.3390/jcm15197639
UR  - https://europepmc.org/article/PMC/PMC13666172
AB  - Background/Objectives: Patients with unresectable glioblastoma (GBM) undergoing biopsy alone represent a clinically heterogeneous population with poor survival and limited access to standard oncological treatment. We investigated clinical, radiological, and histomolecular factors associated with early mortality after biopsy. Methods: We retrospectively analyzed 93 consecutive cases of patients with IDH-wildtype GBM who underwent biopsy without tumor resection between 2013 and 2025. Early death was defined as death within three months of biopsy. Baseline clinical, radiological, and molecular variables were evaluated using univariable analyses and exploratory multivariable logistic regression. Results: Median overall survival was 3 months, and 48/89 patients with available survival data (53.9%) died within three months. Preoperative Karnofsky Performance Status (KPS) and MGMT promoter methylation status (available for 71/93 patients) were nominally associated with early mortality in univariable analyses, although these associations did not remain significant after FDR correction. Age was not significant in univariable analysis but was associated with early mortality after adjustment in the exploratory multivariable model based on 62 complete cases. Conventional radiological parameters showed no consistent association with early death. Exploratory analysis suggested a high-risk phenotype combining KPS ≤ 60 and FLAIR signal crossing the midline. Overall, 23/93 patients (24.7%) did not initiate any adjuvant treatment, while only 17/93 (18.3%) completed the Stupp regimen. Conclusions: Early mortality is frequent in biopsy-only GBM. Clinical and molecular factors may help identify particularly vulnerable patients at diagnosis, supporting individualized treatment planning and shared decision-making. External validation in larger multicenter cohorts is warranted.
SN  - 2077-0383
ER  -