title: Infarct volume after glioblastoma surgery as an independent prognostic factor.
abstract: Postoperative ischemia is associated with reduced functional independence measured by karnofsky performance score (KPS), which correlates well with overall survival. Other studies suggest that postoperative hypoxia might initiate infiltrative tumor growth. Therefore, aim of this study was to analyze the impact of infarct volume on overall survival and progression free survival (PFS) of glioblastoma patients.251 patients with surgery for a newly diagnosed glioblastoma (WHO IV) were retrospectively assessed. Pre- and postoperative KPS, date of death/last follow-up and histopathological markers were recorded. Pre- and postoperative tumor volume and the volume of postoperative infarction were manually segmented.A significant correlation of infarct volume with postoperative KPS decrease (P = 0.001) was observed. Infarct volume showed a significant impact on overall survival (P = 0.014), but not on PFS (P = 0.112) in univariate analysis. This effect increased in the subgroup of patients with near-total tumor resection (> 90%) (overall survival: P = 0.006, PFS: P = 0.066). Infarct volume remained as an independent prognostic factor for overall survival in multivariate analysis (HR 1.013 [1.000-1.026], P = 0.042) including other prognostic factors (age, extent of resection, postoperative KPS).Postoperative infarct volume significantly correlates as an independent factor with overall survival after glioblastoma surgery. Besides the influence of perioperative infarction on postoperative KPS, postoperative hypoxia might also have an effect on tumor biology initiating infiltrative growth and therefore impaired survival.
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Stefanie
authors: S
authors: Bette
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Benedikt
authors: B
authors: Wiestler
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Johannes
authors: J
authors: Kaesmacher
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Thomas
authors: T
authors: Huber
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Julia
authors: J
authors: Gerhardt
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Melanie
authors: M
authors: Barz
authors: Department of Neuropathology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Claire
authors: C
authors: Delbridge
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Yu-Mi
authors: YM
authors: Ryang
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Florian
authors: F
authors: Ringel
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Claus
authors: C
authors: Zimmer
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Bernhard
authors: B
authors: Meyer
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Tobias
authors: T
authors: Boeckh-Behrens
authors: Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Jan S
authors: JS
authors: Kirschke
authors: Department of Neurosurgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors: Jens
authors: J
authors: Gempt
mesh_terms: D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D002545:Brain Ischemia / Q000473:pathology; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery*; D006801:Humans; D000860:Hypoxia; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating
keywords: glioblastoma; infarct volume; karnofsky performance score; overall survival