Radiologic Features and Expression of Vascular Endothelial Growth Factor Stratify Survival Outcomes in Patients with Glioblastoma.

BACKGROUND AND PURPOSE Vascular endothelial growth factor is a well-known tumor-specific biomarker that mediates angiogenesis in glioblastoma via hypoxia-dependent mechanisms. Our aim was to investigate the correlation of clinical characteristics, radiologic features, and vascular endothelial growth factor expression with survival outcomes in patients with glioblastoma. MATERIALS AND METHODS Clinical and radiologic data of 185 patients with glioblastoma were retrospectively reviewed. Vascular endothelial growth factor expression was examined in all cases via immunohistochemical analysis. Univariate and multivariate analyses were performed to identify the prognostic factors of progression-free survival and overall survival. RESULTS Vascular endothelial growth factor expression levels were associated with the presence of ringlike tumor contrast enhancement. Age, preoperative Karnofsky Performance Scale score, gross total resection, and adjuvant therapy were identified as prognostic factors. Among patients undergoing gross total resection, high vascular endothelial growth factor expression was associated with longer progression-free survival (P = .011) and overall survival (P = .039). For tumors with high vascular endothelial growth factor expression, both the non-contrast-enhancing tumor component and peritumoral edema could stratify overall survival (P = .039 and .018, respectively), while only the presence of the non-contrast-enhancing tumor component predicted a longer progression-free survival (P = .024). CONCLUSIONS Vascular endothelial growth factor expression level was not an independent prognostic factor in glioblastoma. However, high vascular endothelial growth factor expression might predict longer survival in patients in whom gross total resection was achieved. Furthermore, peritumoral edema and the non-contrast-enhancing tumor component could stratify survival outcomes in patients with high vascular endothelial growth factor tumors.