BACKGROUND Progress in extending the survival of glioblastoma (GBM) patients has been slow. A better understanding of why patient survival remains poor is critical to developing new strategies. Postmortem studies on GBM can shed light on why patients are dying. METHODS The brains of 33 GBM patients were autopsied and examined for gross and microscopic abnormalities. Clinical-pathologic correlations were accomplished through detailed chart reviews. Data were compared with older published autopsy GBM studies that predated newer treatment strategies, such as more extensive surgical resection and adjuvant temozolomide. RESULTS In older GBM autopsy series, mass effect was observed in 72% of brains, with herniation in 50% of all cases. Infiltration of tumor into the brainstem was noted in only 21% of those older cases. In the current series, only 10 of 33 (30%) GBMs showed mass effect (P = 0.0003), and only 1 (3%) showed herniation (P < 0.0001). However, extensive GBM infiltration of the brainstem was present in 22 cases (67%, P < 0.0001), with accompanying destruction of the pons and white matter tracts. There was a direct correlation between longer median patient survival and the presence of brainstem infiltration (16.1 mo in brainstem-invaded cases vs 9.0 mo in cases lacking extensive brainstem involvement; P = 0.0003). CONCLUSIONS With improving care, severe mass effect appears to be less common in GBM patients today, whereas dissemination, including life-threatening brainstem invasion, is now more pronounced. This has major implications regarding preclinical GBM models, as well as the design of clinical trials aimed at further improving patient survival.

中文翻译：

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广泛的脑干浸润，而非占位效应，是终末期脑胶质母细胞瘤的常见特征。

背景 在延长胶质母细胞瘤 (GBM) 患者的生存期方面进展缓慢。更好地了解为什么患者存活率仍然很低对于制定新策略至关重要。GBM 的死后研究可以阐明患者死亡的原因。方法 对 33 名 GBM 患者的大脑进行尸检并检查大体和微观异常。临床病理相关性是通过详细的图表审查完成的。数据与较早发表的尸检 GBM 研究进行了比较，这些研究早于更新的治疗策略，例如更广泛的手术切除和辅助替莫唑胺。结果 在较早的 GBM 尸检系列中，72% 的大脑观察到占位效应，所有病例的 50% 出现脑疝。只有 21% 的老年病例发现肿瘤浸润到脑干。在当前系列中，33 个 (30%) GBM 中只有 10 个表现出占位效应 (P = 0.0003)，只有 1 个 (3%) 表现出疝气 (P < 0.0001)。然而，22 例（67%，P < 0.0001）存在脑干广泛的 GBM 浸润，伴随着脑桥和白质束的破坏。较长的中位患者生存期与脑干浸润的存在之间存在直接相关性（脑干浸润病例为 16.1 个月，而脑干不广泛受累的病例为 9.0 个月；P = 0.0003）。结论 随着护理的改善，如今严重的占位效应在 GBM 患者中似乎不太常见，而传播，包括危及生命的脑干侵犯，现在更加明显。这对临床前 GBM 模型以及旨在进一步提高患者生存率的临床试验设计具有重大意义。