Multi-institutional validation of a preoperative scoring system which predicts survival for patients with glioblastoma

Abstract

Glioblastoma is the most common and aggressive type of primary brain tumor in adults. Average survival is approximately 1 year, but individual survival is heterogeneous. Using a single institutional experience, we have previously identified preoperative factors associated with survival and devised a prognostic scoring system based on these factors. The aims of the present study are to validate these preoperative factors and verify the efficacy of this scoring system using a multi-institutional cohort. Of the 334 patients in this study from three different institutions, the preoperative factors found to be negatively associated with survival in a Cox analysis were age >60 years (p < 0.0001), Karnofsky Performance Scale score ≤80 (p = 0.03), motor deficit (p = 0.02), language deficit (p = 0.04), and periventricular tumor location (p = 0.04). Patients possessing 0–1, 2, 3, and 4–5 of these variables were assigned a preoperative grade of 1, 2, 3, and 4, respectively. Patients with a preoperative grade of 1, 2, 3, and 4 had a median survival of 17.9, 12.3,10, and 7.5 months, respectively. Survival of each of these grades was statistically significant (p < 0.05) in log-rank analysis. This grading system, based only on preoperative variables, may provide patients and physicians with prognostic information that may guide medical and surgical therapy before any intervention is pursued.

Influence of glioblastoma contact with the lateral ventricle on survival: a meta-analysis

“…All 91 patients in Jafri et al [18] received either erlotinib, cis-retinoic acid, or enzastaurin. In the three studies by Chaichana et al [11, 12, 16], a subset of patients received polifeprosan with carmustine wafer implantation at the surgeon’s discretion (14/52 in the 2008 study). Twenty-six patients in the Tejada-Solis et al study [15] participated in a dendritic cell vaccination trial and irinotecan-bevazucimab was commonly a second line treatment.…”

“…Other confounding variables accounted in these studies included pre-operative motor deficits and intraoperative polifeprosan with carmustine wafer implantation [11, 12, 16], tumor multifocality [14], vaccine administration [15], and MGMT promoter methylation or IDH1 mutation status [22]. …”

Analysis of Olig2 and YKL-40 expression: a clinicopathological/immunohistochemical study for the distinction between subventricular zone II and III glioblastomas

“…Subventricular zone may be a source of tumors with higher proliferative and invasive capaci ties [5]. Recent research efforts in neurooncology are focused in targeting the tumorigenesis theory and to find signal transduction pathways that influence the GB development and change its dismal progno sis, given that surgery and adjuvant chemotherapy with radiotherapy are insufficient due to a diffuse infiltration by tumor tissue into the brain [4,12,37].…”

Metastatic glioblastoma multiforme: A rare case of long-term survival

“…Recently, some reports of targeted therapy and immunotherapy have not been improvement the survival of patients with GBM [3]. Currently, patients usually have a median survival time of approximately 3 months without medical treatment [4]. Treatment in patients with a good performance status is multimodal with surgical resection, radiotherapy and chemotherapy [2,5].…”