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

Purpose 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). Methods 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. Results 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 (OSM+) was 6.0 +/- 0.8 months and median overall survival from initial diagnosis (OSID) 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 OSM+. 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. Conclusions 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.