Clinical characteristics and treatments after diagnosis of extra-CNS metastasis of 150 GBM/ GS patients reported in literature until April 2013.

<p>GBM: Glioblastoma multiforme (including one glioblastoma multiforme with an oligodendroglial component), GS: Gliosarcoma.</p><p>Clinical characteristics and treatments after diagnosis of extra-CNS metastasis of 150 GBM/ GS patients reported in literature until April 2013.</p

Overall survival after the diagnosis of metastasis (OS_M+) according to the period of publication.

<p>A substantial treatment progress has not been achieved over recent decades.</p

Procedure of publication retrieval and in- and exclusion of cases.

<p>Procedure of publication retrieval and in- and exclusion of cases.</p

An Individual Patient Data Meta-Analysis on Characteristics, Treatments and Outcomes of Glioblastoma/ Gliosarcoma Patients with Metastases Outside of the Central Nervous System

<div><p>Purpose</p><p>To determine the characteristics, treatments and outcomes of patients with glioblastoma multiforme (GBM) or gliosarcoma (GS) and metastases outside of the central nervous system (CNS).</p><p>Methods</p><p>PubMed and Web of Science searches for peer-reviewed articles pertaining to GBM/ GS patients with metastatic dissemination were conducted using the keywords gliosarcoma, glioblastoma, GBM, metastasis, metastases and metastatic. Additionally, we performed hand search following the references from the selected papers. Cases with metastases to the CNS were excluded and evaluated in a separate study.</p><p>Results</p><p>109 articles published between 1928 and 2013 were eligible. They reported on 150 patients. We observed a remarkable increase in the number of cases per decade over time. Median overall survival from diagnosis of metastasis (OS_M+) was 6.0 ± 0.8 months and median overall survival from initial diagnosis (OS_ID) 13 ± 2.4 months. On univariate analyses, gender, age, the histological subtype, the time interval between initial diagnosis and diagnosis of metastasis and pulmonary involvement did not influence OS_M+. We did not observe any substantial treatment progress. A comparison of the present cohort with 84 GBM/ GS patients with exclusive CNS dissemination suggests that metastases outside the CNS are related to a slightly more favorable outcome.</p><p>Conclusions</p><p>The occurrence of extra-CNS metastasis from GBM/ GS is associated with a dismal prognosis, however it seems to compare slightly favorable to CNS dissemination. Crucial treatment progress has not been achieved over recent decades. A central registry should be considered to consecutively gain more information about the ideal therapeutic approach.</p></div

Number of case reports on glioblastomas with extra-CNS metastases over the last decades.

<p>Number of case reports on glioblastomas with extra-CNS metastases over the last decades.</p

Evaluation of potential risk factors for overall survival after diagnosis of extra-CNS metastases (OS_M+) using Kaplan Meier method and log rank test.

<p>n: number of patients, OS_M+: overall survival after the diagnosis of metastasis, SE: standard error (months), p: p-value, log-rank test, CI: confidence interval (months), ID: initial diagnosis, GBM: glioblastoma multiforme, GS: gliosarcoma, DoM: diagnosis of metastasis.</p><p>Evaluation of potential risk factors for overall survival after diagnosis of extra-CNS metastases (OS_M+) using Kaplan Meier method and log rank test.</p

Comparison of OS_M+ of the present cohort (42 patients) with OS_M+ of a cohort of GBM/ GS patients with exclusive CNS dissemination (84 patients).

<p>Detailed information on characteristics and treatments of these 84 patients and on data collection has been reported previously [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0121592#pone.0121592.ref009" target="_blank">9</a>].</p