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Machine-Learning-Based Survival Prediction in Glioblastoma Using Graph-Theoretical Analysis of Structural Network Alterations

Stadlbauer A, Oberndorfer S, Heinz G, Marhold F, Kinfe TM, Dorostkar M, Schnell O, Meyer-Bäse U, Meyer-Bäse A (2026)

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Publication Type: Journal article

Publication year: 2026

Journal

Book Volume: 18

Article Number: 1161

Journal Issue: 7

DOI: 10.3390/cancers18071161

Abstract

Background: Glioblastoma is an extremely aggressive brain tumor that diffusely infiltrates white matter and alters large-scale brain connectivity. Most prognostic models focus on localized tumor features and clinical variables, overlooking broader effects on the brain’s structural connectome. This study addressed this limitation by integrating graph-theoretical analysis of preoperative diffusion tensor imaging (DTI)-derived structural connectomes with machine learning (ML) to improve prediction of overall survival (OS) in newly diagnosed glioblastoma. Methods: Preoperative DTI data from 871 glioblastoma patients from the UPenn-GBM and UCSF-PDGM cohorts were processed to construct whole-brain structural connectomes weighted by tract count and quantitative anisotropy (QA). Global and nodal graph-theoretical network metrics were extracted and combined with demographic and clinical information. Ten ML models were trained and validated on 784 patients (90% of the cohort). The three best-performing algorithms were tested on a held-out cohort of 87 patients (10%). Results: Random forest, adaptive boosting, and KStar showed the strongest validation performance. In held-out internal testing, random forest models using degree and QA-weighted strength achieved accuracies of 0.862 and 0.874, with AUROCs of 0.929 and 0.909, for predicting OS beyond one year. Strength and clustering coefficient were key predictors, with over two-thirds of significant nodes localized in the temporal lobe, particularly the parahippocampal, and superior, middle, and inferior temporal gyri. Conclusions: Graph-theoretical quantification of structural brain network disruption combined with ML allows accurate prediction of OS in glioblastoma. These results support a network-based conceptualization of the disease and indicate that connectome-derived metrics may complement established prognostic frameworks.

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How to cite

APA:

Stadlbauer, A., Oberndorfer, S., Heinz, G., Marhold, F., Kinfe, T.M., Dorostkar, M.,... Meyer-Bäse, A. (2026). Machine-Learning-Based Survival Prediction in Glioblastoma Using Graph-Theoretical Analysis of Structural Network Alterations. Cancers, 18(7). https://doi.org/10.3390/cancers18071161

MLA:

Stadlbauer, Andreas, et al. "Machine-Learning-Based Survival Prediction in Glioblastoma Using Graph-Theoretical Analysis of Structural Network Alterations." Cancers 18.7 (2026).

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