The combined EGFR protein expression analysis refines the prognostic value of the MGMT promoter methylation status in glioblastoma

• Prognostic values of MGMT and EGFR were analysed in glioblastoma series.
• Prognostic values of EGFR and MGMT were validated in external data set.
• EGFR expression refines the prognostic value of MGMT in glioblastoma.

Background/aimsTo investigate the combined prognostic value of the EGFR expression level and the MGMT promoter methylation status in Glioblastoma (GB).MethodsWe assessed the EGFR protein expression level by immune-histochemical (IHC) evaluation and the MGMT promoter methylation status by Polymerase Chain Reaction (PCR) in 169 patients affected by GB. We assessed the prognostic significance of combined MGMT methylation status and EGFR expression level in terms of Overall Survival (OS) with univariate and multivariate analysis, and validated this finding using an external data set of GB patient.ResultsClustering survival analysis for the methylation status of MGMT (methMGMT/unmethMGMT) and EGFR expression (High EGFR: H-EGFR; Low EGFR: L-EGFR), identified three different prognostic groups (p = 0.001), as follows. Patients with unmethMGMT/H-EGFR had the shortest survival time (median OS: 5 months) and patients co-expressing methMGMT/L-EGFR had the best prognosis (median OS: 35 months), as compared to the other two sub-groups (methMGMT/H-EGFR; unmethMGMT/L-EGFR), which had respectively median OSs of 11 and 12 months. The combined MGMT methylation and EGFR amplification status analysis showed a similar prognostic impact in an independent series, which we used for validation (p = 0.001).ConclusionsThe EGFR expression evaluation refines the prognostic value of MGMT methylation status in GBs.