Outcome evaluation in glioblastoma patients using different ranking scores: KPS, GOS, mRS and MRC

Abstract

Patient performance is an overall accepted independent prognostic factor in glioblastoma patients. Its estimation is essential for treatment planning, follow-up and clinical trials. Patient performance is mostly determined by usage of the Karnofsky Performance Score (KPS) for cancer patients. However, several other ranking scores have been developed specifically for patients with neurological diseases: Glasgow Outcome Score (GOS) for trauma patients, modified Ranking Score for stroke patients and Medical Research Council brain prognostic index (MRC) for brain tumour patients. The aims of this study were: (1) to compare these four performance scores in their ability to determine patient survival; and (2) to compare the prognostic value of performance with that of other prognostic factors. Univariate and multivariate survival analysis was used. Survival analysis revealed a high correlation to survival for all four scores. The maximum derivation of the curves was shown for the MRC and GOS. Performance had more clinical impact in determining patient survival than age and tumour resection. Differential treatment planning may need the formation of more than two patient groups. This was possible with the MRC, as well as the GOS and KPS. Forming more than three patient groups was not effective with any score.

Prognostic factors in patients with glioblastoma multiforme (clinical research)

“…The MST of the patients in this group was 12 months (CI 95%, 9-15). In the subtotal resection group, 3 (7.7%) of the 39 patients in this group were alive, and the patients' MST was 8 months (CI 95%, [5][6][7][8][9][10][11]. No statistically significant difference was detected in the effect of tumor resection groups on survival times (P > 0.05; Table 2).…”

“…MST was 11 months (CI 95%, [8][9][10][11][12][13][14] in the group without complications, while it was 4 months (CI 95%, 1-7) in the group with complications and the difference was statistically meaningful (P < 0.01; Table 2). In univariate Cox regression analysis, complications were detected as a statistically significant prognostic factor (P < 0.01; Table 3); however, this relation was not detected in the multivariate analysis (P > 0.05; Table 4).…”

“…This, in turn, produces different results (7,13). In general, when the preoperative functional state is studied as an independent variable, patients with elevated Karnofsky scores have more favorable results (1,3,4,(6)(7)(8)(9)13). These studies, however, have an important limitation: although low preoperative KPS (which is significantly correlated to high mortality rates) is included in a statistical assessment, the extent of surgical resection (which is a crucial prognostic factor in multivariate analyses) is not (13).…”

“…Table 2 shows the patient groups with and without RT and CT, their survival rates, and their MSTs. The MST of the patients treated with RT was 11 months (CI 95%, [8][9][10][11][12][13][14], and 17.1% of these patients were alive throughout the follow-up. When the MST of this group was compared to the MST of the group without RT, a statistically significant difference was found (P < 0.01).…”

The Added Prognostic Value of Preoperative Dynamic Contrast-Enhanced MRI Histogram Analysis in Patients with Glioblastoma: Analysis of Overall and Progression-Free Survival

“…2,3 Many investigations have been conducted to elucidate the prognostic factors of glioblastoma, including clinical factors such as age, Karnofsky performance scale (KPS), and extent of tumor resection. 4,5 Molecular and genetic biomarkers of glioblastoma, including O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, epidermal growth factor receptor (EGFR), p53, and Ki-67 index, are also emerging prognostic factors predicting the biologic behavior of tumors. [6][7][8][9][10] However, profiles of molecular biomarkers can only be obtained by invasive procedures such as biopsy or resection.…”