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Document type:
Article; Journal Article
Author(s):
Barz, Melanie; Gerhardt, Julia; Bette, Stefanie; Aftahy, A Kaywan; Huber, Thomas; Combs, Stephanie E; Ryang, Yu-Mi; Wiestler, Benedikt; Skardelly, Marco; Gepfner-Tuma, Irina; Behling, Felix; Schmidt-Graf, Friederike; Meyer, Bernhard; Gempt, Jens
Title:
Prognostic value of tumour volume in patients with a poor Karnofsky performance status scale - a bicentric retrospective study.
Abstract:
BACKROUND: Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤60%. METHODS: We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status. RESULTS: One hundred twenty-three patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. Seventy-five of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0-56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2-15.0 cm3), respectively. The median KPSS was 60% (range 20-60%) preoperatively and 50% (range 0-80%) postoperatively. Patients who received a biopsy showed a median OS for patients who received a biopsy only was 3.0 months (95% CI 2.0-4.0 months), compared to patients who had a resection and had a median OS of 8 months (95% CI 3.1-12.9 months). Age (p < 0.001, HR: 1.045 [95% CI 1.022-1.068]), postoperative tumour volume (p = 0.02, HR: 1.016 [95% CI 1.002-1.029]) and MGMT promotor status (p = 0.016, HR: 0.473 [95% CI 0.257-0.871]) were statistically significant in multivariate analysis. In subgroup analyses only age was shown as a significant prognostic factor in multivariate analyses for patients receiving surgery (p < 0.001, HR: 1.046 [95% CI 1.022-1.072]). In the biopsy group no significant prognostic factors were shown in multivariate analysis. CONCLUSION: GBM patients with a preoperative KPSS of ≤60% might profit from surgical reduction of tumour burden.
Journal title abbreviation:
BMC Neurol
Year:
2021
Journal volume:
21
Journal issue:
1
Fulltext / DOI:
doi:10.1186/s12883-021-02424-0
Pubmed ID:
http://view.ncbi.nlm.nih.gov/pubmed/34781889
Print-ISSN:
1471-2377
TUM Institution:
Fachgebiet Neuroradiologie (Prof. Zimmer); Klinik und Poliklinik für RadioOnkologie und Strahlentherapie; Neurochirurgische Klinik und Poliklinik; Neurologische Klinik und Poliklinik
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