Multivariate analysis of factors affecting postoperative survival in malignant astrocytoma

Abstract

Fifty-eight patients with supratentorial malignant astrocytoma were analyzed statistically to evaluate the factors most important for predicting postoperative survival. Clinical information such as age, sex, duration of preoperative symptom, Karnofsky score at admission and at discharge, location of tumor, amount of tumor removal, number of operations, and postoperative survival in months, together with data on radiation and chemotherapy were analyzed by chi square test, t-test, and multivariate analysis. Cytofluorometric DNA quantification using paraffin embedded specimens was also performed in 20 cases and these data were also evaluated. Multiple correlation coefficient, and therefore the total statistical accuracy, increased to 0.824 when data of DNA quantification, percentages of S phase cells and of polyploid cells, were included. Multivariate analysis revealed that 6 items were the major factors for predicting postoperative survival, i.e. the location of tumor, the Karnofsky score at discharge, the percentage of S phase cells, the number of operations, the percentage of polyploid cells, and the amount of tumor removed. Based on this analysis, the estimated survival time could be expressed as a formula.

Current neurosurgical management and the impact of the extent of resection in the treatment of malignant gliomas of childhood: a report of the Children's Cancer Group Trial No. CCG-945

“…The initial impetus for aggressive surgery was based on results from single-institution surgical series collected over a long period of time. [2,3,18,20,22,25,26,34,40,42] These retrospective reports showed a benefit of radical surgery on survival rates; however, the studies were prone to selection bias and failed to control for important characteristics including patient age and functional status and the tumor's location and histological characteristics, thereby rendering the studies' conclusions suspect. Further limitations on analysis of single-institution series are imposed by patterns of referral, incomplete follow-up information, and other missing data.…”

“…[8,12,16,[18][19][20]23,30,35,36,41,49] Our patients were not preselected for functional status and were representative of the entire pediatric cohort eligible for radiation therapy with similar numbers of patients in each hemidecade ( Table 1). Reports of improved survival benefit for radical resection of malignant astrocytomas have been criticized for a basis in selecting out younger patients (among a population of adults) with better functional status.…”

Subcortical mapping and monitoring during insular tumor surgery

“…[15][16][17]32,37,47,56,61 From an oncological point of view, the resection rate correlates with the survival rate. 1,8,25,33 The clinical relevance of intraoperative mapping and monitoring has been demonstrated in various publications. 3,4,7,18,19,34,40,48,60 Intraoperative mapping and monitoring involving CMAPs is a valid modality for reducing iatrogenic morbidity during surgery in and around the central region as well as for intracranial aneurysms.…”

Local and sustained delivery of 5-fluorouracil from biodegradable microspheres for the radiosensitization of glioblastoma

“…29 However a critical analysis must consider factors other than surgery that are well known to influence survival time in patients with high grade glioma such as the patient's age and performance status. 30 Further studies will enable us to confirm the tolerance and effect on survival of this new approach.…”