Scale to predict survival after surgery for recurrent glioblastoma multiforme.
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.
Park
John K
JK
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
Hodges
Tiffany
T
Arko
Leopold
L
Shen
Michael
M
Dello Iacono
Donna
D
McNabb
Adrian
A
Olsen Bailey
Nancy
N
Kreisl
Teri Nguyen
TN
Iwamoto
Fabio M
FM
Sul
Joohee
J
Auh
Sungyoung
S
Park
Grace E
GE
Fine
Howard A
HA
Black
Peter McL
PM
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