Preoperative prognostic neurologic index for glioblastoma patients receiving tumor resection.
BACKGROUND
Neurologic status is one of the major prognostic factors in glioblastoma patients; however, no consensus exists on a clinical index for predicting patient outcomes. The purpose of this study was to evaluate the correlation between neurologic deficits and clinical outcomes in glioblastoma patients, and to develop a prognostic neurologic index for identifying patients with poor outcomes.


METHODS
Patients receiving tumor resection with pathologically confirmed glioblastoma were retrospectively evaluated. The patients' preoperative neurologic deficits were categorized, and patients with poor overall survival (OS) were identified. Other common prognostic factors, including age, performance, imaging findings, and extent of resection, were analyzed.


RESULTS
We evaluated 162 glioblastoma patients receiving tumor resection between February 2000 and December 2011, of whom 54 received adjuvant radiotherapy (RT) alone and 84 received concurrent chemo-RT with temozolomide. At a median follow-up of 57.6 (range 26.3-88.9) months, 26 patients had survived without loss to follow-up. We defined adverse neurologic status by using an index of combined increased intracranial pressure (IICP) and non-IICP signs. In univariate analysis, the median OS of patients with and without adverse neurologic status were 9.6 and 18.7 months, respectively (p < 0.001). In multivariate analyses, adverse neurologic status remained significantly associated with poor OS (hazard ratio 2.18, 95 % confidence interval 1.54-3.10).


CONCLUSIONS
Our proposed neurologic index enables significantly identifying glioblastoma patients receiving tumor resection with poor outcomes, independent of other common prognostic factors. Using the index provides a preoperative predictor of prognosis in glioblastoma patients receiving tumor resection.
Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
Hsiang-Kuang
HK
Liang
Chun-Wei
CW
Wang
Han-Min
HM
Tseng
Chao-Yuan
CY
Huang
Keng-Hsueh
KH
Lan
Yu-Hsuan
YH
Chen
San-Lin
SL
You
Jason Chia-Hsien
JC
Cheng
Ann-Lii
AL
Cheng
Sung-Hsin
SH
Kuo
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005909:Glioblastoma / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009422:Nervous System Diseases / Q000150:complications* / Q000503:physiopathology; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult