Clinical Significance of Early Venous Filling Detected via Preoperative Angiography in Glioblastoma

SIMPLE SUMMARY: Our study examined early venous filling (EVF) on angiography, a potential sign of aggressiveness in a type of brain cancer known as glioblastoma (GBM). The study aimed to determine if there were differences in survival rates between GBM patients with and without EVF, and if EVF was associated with a neovascularization process called vascular mimicry. Vascular mimicry occurs when cancer cells form blood vessel-like structures, making the cancer more aggressive and difficult to treat. The study found that GBM patients with EVF generally had shorter survival and were more likely to show signs of vascular mimicry. Simply put, the presence of EVF in GBM patients may indicate a more aggressive form of the disease, which could lead to a worse prognosis. This finding could potentially help physicians predict disease progression and tailor treatment plans. However, more research is needed to confirm these findings and to understand whether they could be used to develop new treatments. ABSTRACT: Preoperative angiography in glioblastoma (GBM) often shows arteriovenous shunts and early venous filling (EVF). Here, we investigated the clinical implications of EVF in GBM as a prognostic and vascular mimicry biomarker. In this retrospective multicenter study, we consecutively enrolled patients who underwent angiography with a GBM diagnosis between 1 April 2013 and 31 March 2021. The primary and secondary endpoints were the differences in overall survival (OS) and progression-free survival (PFS), respectively, between cases with and without EVF. Of the 133 initially enrolled patients, 91 newly diagnosed with GBM underwent preoperative angiography and became the study population. The 6-year OS and PFS were significantly worse in the EVF than in the non-EVF group. Moreover, 20 GBM cases (10 with EVF and 10 without EVF) were randomly selected and evaluated for histological vascular mimicry. Except for two cases that were difficult to evaluate, the EVF group had a significantly higher frequency of vascular mimicry than the non-EVF group (0/8 vs. 5/10, p = 0.04). EVF on preoperative angiography is a robust prognostic biomarker for GBM and may help detect cases with a high frequency of histological vascular mimicry.