Background: Lesion network mapping (LNM) is a popular framework for assessing clinical syndromes following brain damage. The classical approach involves embedding patients’ lesions into a normative functional connectome and using the corresponding functional maps as proxies for disconnection patterns. However, previous studies have shown limited predictive power of this approach in behavioral deficits. We hypothesized similarly low predictability for overall survival (OS) in glioblastoma (GBM).
Methods: A retrospective dataset of patients with GBM (n = 99) was included. Lesion masks were registered into normative space to compute disconnection maps. The normative functional brain connectome consisted of data from 173 healthy subjects obtained from the Human Connectome Project. A modified version of the LNM was then applied to the main regions of the GBM masks. Linear regression, classification analyses, and principal component analysis (PCA) were conducted to explore the relationship between disconnection and OS. OS was considered both as a continuous and as a categorical variable (low, intermediate, and high survival).
Results: The results did not reveal significant associations between OS and network disconnection strength when analyzed both at the voxel level and through classification analyses. Moreover, patients stratified into different OS groups did not show significant differences in network connectivity patterns. The spatial similarity between the first PCA components of network maps for each OS group suggested a lack of distinctive network patterns associated with survival duration.
Conclusions: Compared to indirect structural measures, indirect functional mapping does not provide significant predictive power for OS in patients with GBM. These findings are consistent with previous research demonstrating the limitations of indirect functional measures in predicting clinical outcomes, highlighting the need for more comprehensive methodologies and a deeper understanding of the factors influencing clinical outcomes in this complex disease.
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