Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor: Results from a systematic review and meta-analysis

Mueez Waqar, Federico Roncaroli, Eric J. Lehrer, Joshua D. Palmer, Javier Villanueva-Meyer, Steve Braunstein, Emma Hall, Marianne Aznar, Philip C. De Witt Hamer, Pietro I. D'Urso, Daniel Trifiletti, Alfredo Quiñones-Hinojosa, Pieter Wesseling, Gerben R. Bors

Research output: Contribution to journalReview articlepeer-review


Background: In patients with newly diagnosed glioblastoma, rapid early progression (REP) refers to tumor regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised previously published data on REP to better characterize and understand it. Methods: Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to October 21, 2021. Studies describing the incidence of REP - tumor growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly diagnosed glioblastoma were included. The primary outcome was REP incidence. Results: From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0-58.8 y). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1-1.5). The median number of days between MRI scans was 34 days (IQR 18-45 days). The mean incidence rate of REP was 45.9% (range 19.3%-72.0%) and significantly lower in studies employing functional imaging to define REP (P < .001). REP/non-REP groups were comparable with respect to age (P = .99), gender (P = .33) and time between scans (P = .81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30-2.43, P < .001), shortened progression-free survival (HR 1.78, 95% CI 1.30-2.43, P < .001), subtotal resection (OR 6.96, 95% CI 4.51-10.73, P < .001) and IDH wild-type versus mutant tumors (OR 0.20, 95% CI 0.02-0.38, P = .03). MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72-2.28, P = .39). Conclusions: REP occurs in almost half of patients with newly diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.

Original languageEnglish (US)
Article numbervdac075
JournalNeuro-Oncology Advances
Issue number1
StatePublished - Jan 1 2022


  • IDH
  • MGMT
  • REP
  • extent of resection
  • glioblastoma
  • prognosis
  • progression
  • recurrence
  • survival

ASJC Scopus subject areas

  • Clinical Neurology
  • Oncology
  • Surgery


Dive into the research topics of 'Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor: Results from a systematic review and meta-analysis'. Together they form a unique fingerprint.

Cite this