title: Scale to predict survival after surgery for recurrent glioblastoma multiforme.
abstract: OBJECTIVE
  Despite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.
  
  
  METHODS
  The preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. The factors associated with decreased postoperative survival (P < .05) were used to devise a prognostic scale which was validated with a separate cohort of 109 patients.
  
  
  RESULTS
  The factors associated with poor postoperative survival were: tumor involvement of prespecified eloquent/critical brain regions (P = .021), Karnofsky performance status (KPS) < or = 80 (P = .030), and tumor volume > or = 50 cm(3) (P = .048). An additive scale (range, 0 to 3 points) comprised of these three variables distinguishes patients with good (0 points), intermediate (1 to 2 points), and poor (3 points) postoperative survival (median survival, 10.8, 4.5, and 1.0 months, respectively; P < .001). The scale identified three statistically distinct groups within the validation cohort as well (median survival, 9.2, 6.3, and 1.9 months, respectively; P < .001).
  
  
  CONCLUSIONS
  We devised and validated a preoperative scale that identifies patients likely to have poor, intermediate, and good relative outcomes after surgical resection of a recurrent GBM tumor. Application of this simple scale may be useful in counseling patients regarding their treatment options and in designing clinical trials.
authors.affiliation: Surgical and Molecular Neurooncology Unit, National Institute of Neurological Disorders and Stroke,Neuro-oncology Branch, National Cancer Institute and National Institute of Arthritis and Musculoskeletal andSkin Diseases, National Institutes of Health, Bethesda, MD 20892, USA. parkjk@ninds.nih.gov
authors.forename: John K
authors.initials: JK
authors.lastname: Park
authors.forename: Tiffany
authors.initials: T
authors.lastname: Hodges
authors.forename: Leopold
authors.initials: L
authors.lastname: Arko
authors.forename: Michael
authors.initials: M
authors.lastname: Shen
authors.forename: Donna
authors.initials: D
authors.lastname: Dello Iacono
authors.forename: Adrian
authors.initials: A
authors.lastname: McNabb
authors.forename: Nancy
authors.initials: N
authors.lastname: Olsen Bailey
authors.forename: Teri Nguyen
authors.initials: TN
authors.lastname: Kreisl
authors.forename: Fabio M
authors.initials: FM
authors.lastname: Iwamoto
authors.forename: Joohee
authors.initials: J
authors.lastname: Sul
authors.forename: Sungyoung
authors.initials: S
authors.lastname: Auh
authors.forename: Grace E
authors.initials: GE
authors.lastname: Park
authors.forename: Howard A
authors.initials: HA
authors.lastname: Fine
authors.forename: Peter McL
authors.initials: PM
authors.lastname: Black
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D047368:Tumor Burden