title: Glioblastoma: clinical characteristics, prognostic factors and survival in 492 patients.
abstract: OBJECTIVE
  Glioblastoma is the most common and most malignant primary brain tumor in adults. The only overall accepted independent prognostic factors are patient age and performance. We present a large single institution patient series examined for prognostic factors using uni- and multivariate survival analysis.
  
  
  METHODS
  492 patients were included who underwent craniotomy for newly diagnosed glioblastoma WHO grade IV between 1990 and 2007 at our department. The association to patient survival was estimated using log-rank test for univariate analysis and cox regression method for multivariate analysis.
  
  
  RESULTS
  Median patient age was 62 years (mean: 60.4 years, range: 22-93 years), the male: female ratio was 1.26:1. Primary genesis was found in 91.0% of cases. A multifocal tumor was present in 110 cases (22.4%). The median pre- and post-operative Karnofsky Performance Score was 70. Total tumor resection was performed in 288 cases (58.5%), subtotal removal in 134 cases (27.2%). The following parameters were significantly associated with survival in univariate analysis: age, performance, primary genesis, multifocal tumor, neurological deficit, neuropsychological findings, seizures, incidental finding, total or subtotal resection, radiotherapy, chemotherapy, combined radio-/chemotherapy with temozolomide, re-craniotomy, second tumor in patient history. The following parameters were significantly associated with survival in multivariate analysis: age, performance, multifocal tumor, total or subtotal resection, radiotherapy, chemotherapy, combined radio-/chemotherapy with temozolomide.
  
  
  CONCLUSIONS
  In addition to patient age and performance, we identified multiple lesions and resection status as independent prognostic factors. Radiotherapy, chemotherapy and combined radio-/chemotherapy with temozolomide were significantly associated with prolonged survival.
authors.affiliation: Department of Neurosurgery, Schleswig-Holstein University Medical Center, Campus Kiel, Arnold-Heller-Str. 3, Building 41, D-24105 Kiel, Germany. starka@nch.uni-kiel.de
authors.forename: Andreas M
authors.initials: AM
authors.lastname: Stark
authors.forename: Julia
authors.initials: J
authors.lastname: van de Bergh
authors.forename: Jürgen
authors.initials: J
authors.lastname: Hedderich
authors.forename: H Maximilian
authors.initials: HM
authors.lastname: Mehdorn
authors.forename: Arya
authors.initials: A
authors.lastname: Nabavi
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003399:Craniotomy; D003606:Dacarbazine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D005909:Glioblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000379:methods; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D013534:Survival; D000077204:Temozolomide; D055815:Young Adult
chemical_list: D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide