Discordant Molecular, Imaging, and Survival Manifestations between Molecular Glioblastomas and Histological Glioblastomas

Motivation: Whether molecular GBMs are equivalent to early histological GBMs are controversial. Goal(s): To compare the clinicopathologic, imaging, surgical factors, and prognosis between molecular GBMs and histological GBMs. Approach: Retrospective chart and imaging review was performed in 974 IDH-wildtype GBM patients (43 molecular GBMs and 931 histological GBMs) from a single institution. Results: Molecular GBMs were significantly younger with higher rate of TERTp, higher incidence of gliomatosis cerebri and non-lobar location compared with histological GBMs, resulting in less aggressive resection. Survival was significantly longer in molecular GBM, which was attributed to the longer OS in histological grade 2 molecular GBMs with isolated TERTp mutation. Impact: Discordant clinicopathologic, imaging, and surgical features suggest molecular GBMs may not be equivalent to early histological GBMs. Histological grade 2 molecular GBMs with isolated TERTp mutation may not be sufficient to assume an aggressive clinical behavior similar to histological GBM.