{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T05:04:50Z","timestamp":1789535090264,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Level-1 evidence supports adjuvant temozolomide (TMZ) after chemoradiotherapy in newly diagnosed glioblastoma, but many patients discontinue before completing the six cycles the regimen calls for\u2014particularly in China, where long-term outcome data anchored to treatment intensity remain scarce. We quantified the independent prognostic value of completing \u22656 cycles of adjuvant TMZ in a 17-year single-center Chinese glioma cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We retrospectively assembled 319 patients with pathologically confirmed glioma treated between 2009 and June 2026 at a tertiary Chinese center; 264 with complete grade, follow-up, resection, and radiotherapy data (tier A) formed the primary cohort. Overall survival (OS) was analyzed by Kaplan\u2013Meier estimation and grade-stratified Cox regression. Robustness of the TMZ \u22656-cycle effect was probed by landmark analyses at 3, 6, 9, and 12 months; inverse-probability-of-treatment weighting (IPTW); restricted mean survival time (RMST); cause-specific Cox regression; prespecified subgroup\/interaction analyses; and\n                      <jats:italic>E<\/jats:italic>\n                      -value sensitivity analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Median follow-up was 79 months (IQR 42\u2013115); 133 patients (50.4%) died. Five-year OS was 81.8% in WHO I\u2013II, 42.2% in III, and 24.2% in IV (log-rank\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.0001). The stratified Cox model showed that \u22656 adjuvant TMZ cycles independently halved mortality (adjusted HR 0.46, 95% CI 0.31\u20130.67,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), alongside age \u226560 (HR 1.97, 1.30\u20132.98) and radiotherapy boost\/SIB (HR 1.59, 1.01\u20132.49). The effect held across all four landmarks (HR 0.44\u20130.60), after IPTW (HR 0.42, 0.29\u20130.62), and in the cause-specific model (HR 0.45, 0.31\u20130.67). RMST yielded 17.0 additional months at 5 years and 30.3 months at 10 years within WHO IV. In histologic glioblastoma, the pattern was threshold-shaped: 1\u20135 cycles fared no better than none (HR 0.86,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.62), whereas \u22656 cycles conferred a 64% mortality reduction (HR 0.36, 0.17\u20130.75).\n                      <jats:italic>E<\/jats:italic>\n                      -values were 3.79 (point estimate) and 2.33 (CI limit nearer the null).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Completion of \u22656 cycles of adjuvant temozolomide was the strongest modifiable prognostic factor for OS in high-grade glioma, robust across multiple bias-mitigation frameworks, although residual confounding by unmeasured molecular subtype and baseline functional status cannot be fully excluded. Completion\u2014not merely initiation\u2014of adjuvant TMZ warrants explicit tracking as a quality-of-care metric.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1933534","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T04:34:20Z","timestamp":1789533260000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Completion of \u22656 cycles of adjuvant temozolomide is the strongest modifiable prognostic factor in glioblastoma: a 17-year real-world cohort of 319 glioma patients from a single Chinese center"],"prefix":"10.3389","volume":"16","author":[{"given":"Pei","family":"Liu","sequence":"first","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaotang","family":"Xiao","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiquan","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kebei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Liu","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Liu","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huixian","family":"Huang","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Pang","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiping","family":"Lu","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Defeng","family":"Qing","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Liang","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siting","family":"Lin","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Chen","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heming","family":"Lu","sequence":"additional","affiliation":[{"name":"First and Second Division of Department of Radiation Oncology, Guangxi Academy of Medical Sciences and People\u2019s Hospital of Guangxi Zhuang Autonomous Region","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1201\/9781003416197-1","article-title":"Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N Engl J Med"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1038\/s41571-020-00447-z","article-title":"EANO guidelines on the diagnosis and treatment of diffuse gliomas of adulthood","volume":"18","author":"Weller","year":"2021","journal-title":"Nat Rev Clin 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