Predicting progression-free survival in glioblastoma with neuroimaging and machine learning

Clinical Snapshot

Key Findings

• P Value: p < 0.001 for overall model performance

• Effect Size: R² = 0.96 for PFS prediction model

• Primary Outcome: Progression-free survival prediction accuracy

• Nnt Or Sensitivity: RMSE = 1.26 months, MAE = 1.08 months for PFS prediction

• Confidence Interval: Not reported

Clinical Application

Limited by requirement for specialised resting-state fMRI analysis and machine learning infrastructure Relevant for major Australian neurosurgical centres with advanced neuroimaging capabilities. May inform treatment planning and patient counselling, though implementation would require significant technical resources Newly diagnosed glioblastoma patients with access to advanced neuroimaging

Abstract

PURPOSE: Glioblastoma (GBM) is the most prevalent and aggressive form of malignant glioma. Reliable estimation of progression-free survival (PFS) prior to medical intervention could strengthen clinical decision-making and improve patient care. Here, we utilize machine learning (ML) to predict PFS in GBM patients using resting state network (RSN) connectivity before medical intervention. METHODS: GBM patients (N = 45, mean age 62.1 ± 10.3 years, mean PFS 9.5 ± 5.6 months, 62.2% male) were retrospectively recruited from Washington University Medical Center. All patients completed structural neuroimaging and resting-state functional MRI before surgery. Deep neural networks were trained on resting-state functional connectivity to predict PFS. Feature selection identified the 15 strongest predictive features prior to training. RESULTS: Sex (p = 0.0037), overall survival (p = 0.0003), MGMT promoter methylation status (p = 0.0064), presentation of weakness (p = 0.0037), and presentation of memory impairment (p = 0.045) were significantly associated with PFS. Tumor frequency and spatial correlation analyses associated dorsal attention, visual, frontal-parietal, and default mode networks with shorter PFS. Conversely, right-temporal lobe tumors were associated with better outcomes. RSN spatial maps revealed widespread alterations in association networks in GBM patients relative to controls. MRMR feature selection identified thalamic and association network connectivity, including somatomotor, ventral and dorsal attention, and default mode/parietal memory as the strongest predictors of PFS. Using leave-one-out validation, the model predicted PFS with an RMSE of 1.26 months, MAE of 1.08 months, and R² of 0.96 (p < 0.001). CONCLUSIONS: Our findings indicate that GBM alters functional brain organization on a widespread scale, and these global effects are informative of patient outcomes.

References

1. 1.Hickman-Chow, D. A., Luckett, P. H., Olufawo, M., Dierker, D., Shimony, J. S., & Leuthardt, E. C. (2026). Predicting progression-free survival in glioblastoma with neuroimaging and machine learning. Journal of Neuro-Oncology. https://doi.org/10.1089/brain.2018.0623