Factors associated with survival for patients with glioblastoma with poor pre-operative functional status

Abstract

Patients with glioblastoma (GB) are known to have poor prognoses, and among these patients, those with poor neurological function have an even poorer prognosis. Consequently, aggressive surgeries and adjuvant therapies are often withheld because of this dismal outlook. The effects of aggressive therapies in this small subset of patients remain unknown. The goal of this study was to evaluate outcomes and factors associated with survival for poor functioning patients who underwent aggressive resection of their GB. Adult patients who underwent surgical resection of an intracranial primary GB at an academic tertiary-care institution between 1997 and 2007 were retrospectively reviewed. Patients with a Karnofsky Performance Scale (KPS) score of ≤60 were included. A total of 100 patients with primary GB met the inclusion criteria. The average age (±standard deviation) and KPS score of this cohort were 54 ± 15 years and 53 ± 12, respectively. No patient (0%) experienced perioperative mortality, and 0 (0%), 10 (10%), and 3 (3%) of patients incurred a new or increasing language, motor, and visual deficit, respectively. At last follow-up, 88 (88%) patients died with a median survival of 6.6 months. The factors associated with improved survival were age <65 year (p = 0.005), tumor size >2 cm (p = 0.01), radical tumor resection (p = 0.01), and temozolomide (p = 0.001). This study identifies a subset of patients with poor functional status who may benefit from aggressive surgical resection.

Treatment and Outcomes for Glioblastoma in Elderly Compared with Non-elderly Patients: A Population-Based Study

“…That finding contrasts with multiple earlier studies that demonstrated a strong predictive value for surgical resection in patients with gbm 15,20,21 . In our study, the number of non-elderly patients who did not undergo resection was quite small compared with the resected group (9 patients and 73 patients respectively).…”

The relative value of postoperative versus preoperative Karnofsky Performance Scale scores as a predictor of survival after surgical resection of glioblastoma multiforme

“…Indeed, McGirt et al [12] demonstrated that acquired postoperative deficits are associated with decreased OS, but our results indicate that the converse is also true. This has been supported by results in studies using alternative measures of functional status and quality of life which have correlated improved OS with an increase in functional status and quality of life after surgery [19,20,22,26].…”

“…Previously published reports describing KPS scores as predictors of outcome in patients with gliomas rely on evaluation of preoperative KPS scores and their associations with outcome [3,4,7,8,[18][19][20]. However, patients presenting with GBM are uniquely prone to symptoms that may confound accurate interpretation of their overall performance status including seizures, acute mental status changes, and focal neurologic deficits [21].…”

Brachyury-YAP Regulatory Axis Drives Stemness and Growth in Cancer

“…While chordomas are characteristically slow-growing tumors with a median patient survival of 7 years (McMaster et al, 2001), GBM are the most common and aggressive type of primary brain cancer, and have a dismal patient prognosis with an overall median survival of only 14.6 months (Chaichana et al, 2013a; Chaichana et al, 2013b; Smith et al, 2015; Stupp et al, 2005). Thus, it was of interest to investigate the potential role of brachyury in driving stemness and growth in this highly proliferative and aggressive CNS-derived cancer.…”

“…By binding to the proximal region of the YAP promoter, brachyury was found to transactivate YAP-dependent signaling in chordoma. Furthermore, we find that brachyury expression is elevated in glioblastomas (GBM), the most common and aggressive type of primary brain cancer (Chaichana et al, 2013a; Chaichana et al, 2013b; Smith et al, 2015; Stupp et al, 2005), and in a majority of brain metastases derived from various carcinomas. Surprisingly, we also observed that brachyury enhanced YAP signaling in lung cancer cells by increasing protein stability instead of transcriptional activation, suggesting a dual role of brachyury in YAP expression.…”