The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma.
OBJECTIVE An increased extent of resection (EOR) has been shown to improve overall survival of patients with glioblastoma (GBM) but has the potential for causing a new postoperative neurological deficit. To investigate the impact of surgical neurological morbidity on survival, the authors performed a retrospective analysis of the clinical data from patients with GBM to quantify the impact of a new neurological deficit on the survival benefit achieved with an increased EOR. METHODS The data from all GBM patients who underwent resection at the University of Florida from 2010 to 2015 with postoperative imaging within 72 hours of surgery were included in the study. Retrospective analysis was performed on clinical outcomes and tumor volumes determined on postoperative and follow-up imaging examinations. RESULTS Overall, 115 patients met the inclusion criteria for the study. Tumor volume at the time of presentation was a median of 59 cm3(enhanced on T1-weighted MRI scans). The mean EOR (± SD) was 94.2% ± 8.7% (range 59.9%-100%). Almost 30% of patients had a new postoperative neurological deficit, including motor weakness, sensory deficits, language difficulty, visual deficits, confusion, and ataxia. The neurological deficits had resolved in 41% of these patients on subsequent follow-up examinations. The median overall survival was 13.1 months (95% CI 10.9-15.2 months). Using a multipredictor Cox model, the authors observed that increased EOR was associated with improved survival except for patients with smaller tumor volumes (≤ 15 cm3). A residual volume of 2.5 cm3or less predicted a favorable overall survival. Developing a postoperative neurological deficit significantly affected survival (9.2 months compared with 14.7 months, p = 0.02), even if the neurological deficit had resolved by the first follow-up. However, there was a trend of improved survival among patients with resolution of a neurological deficit by the first follow-up compared with patients with a permanent neurological deficit. Any survival benefit from achieving a 95% EOR was abrogated by the development of a new neurological deficit postoperatively. CONCLUSIONS Developing a new neurological deficit after resection of GBM is associated with a decrease in overall survival. A careful balance between EOR and neurological compromise needs to be taken into account to reduce the likelihood of neurological morbidity from surgery.
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Maryam
M
Rahman
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Joseph
J
Abbatematteo
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Edward K
EK
De Leo
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Paul S
PS
Kubilis
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Sasha
S
Vaziri
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Frank
F
Bova
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Elias
E
Sayour
Department of Neurosurgery, University of Florida, Gainesville, Florida; and.
Duane
D
Mitchell
Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland.
Alfredo
A
Quinones-Hinojosa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000401:mortality* / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005909:Glioblastoma / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000401:mortality*; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
EOR = extent of resection; GBM = glioblastoma; HR = hazard ratio; HRQOL = health-related quality of life; KPS = Karnofsky Performance Scale; RV = residual volume; extent of resection; glioblastoma; iMRI = intraoperative MRI; neurological deficit; oncology; postoperative morbidity; quality of life; resection