title: Efficacy of Surgery and Further Treatment of Progressive Glioblastoma.
abstract: BACKGROUND
  Treatment options for patients with glioblastoma at progression have remained controversial, and selection criteria for the appropriate type of intervention remain poorly defined. The objectives were to determine which factors favor the decision for second surgery and which factors are associated with overall survival (OS) and to evaluate the National Institutes of Health (NIH) recurrent glioblastoma scale. The scale includes tumor involvement of eloquent brain regions, functional status, and tumor volume.
  
  
  METHODS
  A retrospective single-center analysis of patients with newly diagnosed glioblastoma undergoing initial surgery between January 2007 and December 2011 was performed. Patients were separated into two groups: those with versus those without second resection surgery at disease progression. OS was compared using the multiple logistic regression model, Cox proportional hazard regression, and Kaplan-Meier survival analysis.
  
  
  RESULTS
  The data of 98 patients were statistically analyzed. Among the patients, 58 had initial surgery only (age 61.27 years; median OS [mOS] 14.81 months) and 40 underwent second surgery at disease progression (age 55 years; mOS 18.86 months). Age was the only predictor for repeated surgery (P = 0.012; odds ratio 0.94). At the time of tumor progression, administration of alkylating chemotherapy (P = 0.004; hazard ratio [HR] 0.24) or bevacizumab (P = 0.001; HR 0.23) was associated with longer OS. Reoperation was associated with a lower HR (P = 0.134; HR 0.66). The NIH recurrent glioblastoma scale showed statistically significant improvement of prognosis prediction with the addition of age.
  
  
  CONCLUSIONS
  Surgery of progressive glioblastoma and postoperative treatment at the time of progression is associated with improved OS in some patients. The addition of age may improve survival prediction of the NIH recurrent glioblastoma scale.
authors: Department of Neurosurgery, University Hospital Zurich, Switzerland.
authors: Christoph Michael
authors: CM
authors: Woernle
authors: Department of Neurosurgery, University Hospital Zurich, Switzerland. Electronic address: dompeus@gmail.com.
authors: Dominik
authors: D
authors: Péus
authors: Department of Oncology, University Hospital Zurich, Switzerland.
authors: Silvia
authors: S
authors: Hofer
authors: Department of Neuropathology, University Hospital Zurich, Switzerland.
authors: Elisabeth Jane
authors: EJ
authors: Rushing
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University Hospital Zurich, Switzerland.
authors: Ulrike
authors: U
authors: Held
authors: Department of Neurosurgery, University Hospital Zurich, Switzerland.
authors: Oliver
authors: O
authors: Bozinov
authors: Department of Neurosurgery, University Hospital Zurich, Switzerland.
authors: Niklaus
authors: N
authors: Krayenbühl
authors: Department of Neurology, University Hospital Zurich, Switzerland.
authors: Michael
authors: M
authors: Weller
authors: Department of Neurosurgery, University Hospital Zurich, Switzerland.
authors: Luca
authors: L
authors: Regli
mesh_terms: D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Bevacizumab; Glioblastoma; Neurosurgery; Prognostic score; Recurrence; Temozolomide