Volumetric MRI-Based Response Assessment and Prognostic Value in Newly Diagnosed Glioblastoma: RANO 2.0 vs. mRANO vs. RANO

Abstract Background This retrospective study employed volumetric MRI assessment to compare three response assessment criteria: RANO 2.0, mRANO, and RANO, in patients with newly diagnosed glioblastoma (GB) treated with standard-of-care therapy. We evaluated whether progression-free survival (PFS), defined by each criterion, serves as a prognostic marker for overall survival (OS), and evaluated the impact of progression on patient outcome using landmark analyses. Methods 137 GB patients were included. Tumor volumes were assessed using semiautomatic 3D segmentation of contrast-enhancing and T2/FLAIR lesions on serial MRI. PFS was determined using RANO, mRANO, and RANO 2.0 criteria. Correlation between PFS and OS was evaluated using Spearman’s rank test. Differences in PFS and post-progression survival were tested with the Kruskal-Wallis test and corrected for multiple testing. Landmark analyses at 8 and 12 months were conducted to assess the prognostic effect of progression, with hazard ratios (HR) derived from Cox models. Results Median PFS differed significantly across criteria: 7.9 months (RANO), 11.3 months (mRANO), and 9.7 months (RANO 2.0). The correlation of PFS with OS was best with mRANO (ρ = 0.70), followed by RANO 2.0 (ρ = 0.66) and RANO (ρ = 0.50). The highest HR for death in patients with progressive disease was seen with RANO 2.0 (HR = 3.6), followed by mRANO (HR = 3.3), and RANO (HR = 3.3) (8-month landmark). Conclusion mRANO and RANO 2.0 provided strong prognostic value in newly diagnosed GB patients. mRANO and RANO 2.0 showed strong correlation between PFS and OS, while RANO 2.0 demonstrated the strongest stratification of survival risk based on progression status at landmarks.