Prognostic factors for survival in 676 consecutive patients with newly diagnosed primary glioblastoma

Abstract

Reliable data on large cohorts of patients with glioblastoma are needed because such studies differ importantly from trials that have a strong bias toward the recruitment of younger patients with a higher performance status. We analyzed the outcome of 676 patients with histologically confirmed newly diagnosed glioblastoma who were treated consecutively at a single institution over a 7-year period (1997-2003) with follow-up to April 30, 2006. Survival probabilities were 57% at 1 year, 16% at 2 years, and 7% at 3 years. Progression-free survival was 15% at 1 year. Prolongation of survival was significantly associated with surgery in patients with a good performance status, whatever the patient's age, with an adjusted hazard ratio of 0.55 (p < 0.001) or a 45% relative decrease in the risk of death. Radiotherapy and chemotherapy improved survival, with adjusted hazard ratios of 0.61 (p = 0.001) and 0.89 (p = 0.04), respectively, regardless of age, performance status, or residual tumor volume. Recurrence occurred in 99% of patients throughout the follow-up. Reoperation was performed in one-fourth of these patients but was not effective, whether performed within 9 months (hazard ratio, 0.86; p = 0.256) or after 9 months (hazard ratio, 0.98; p = 0.860) of initial surgery, whereas second-line chemotherapy with procarbazine, lomustine, and vincristine (PCV) or with temozolomide improved survival (hazard ratio, 0.77; p = 0.008). Surgery followed by radiotherapy and chemotherapy should be considered in all patients with glioblastoma, and these treatments should not be withheld because of increasing age alone. The benefit of second surgery at recurrence is uncertain, and new trials are needed to assess its effectiveness. Chemotherapy with PCV or temozolomide seems to be a reasonable option at tumor recurrence.

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).…”

“…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).…”

“…Although some studies (1,3,4,7,8,11) reported that localization is a crucial and effective factor in prognosis, others (6,14) reported the absence of a relationship between localization and prognosis.…”

Role of adjuvant or salvage radiosurgery in the management of unresected residual or progressive glioblastoma multiforme in the pre–bevacizumab era

“…3, 8,10,43 Although multimodality management remains largely palliative, median survival times (MSTs) of 14.6 months are now possible. Conventional fractionated RT, to cumulative doses of 60 Gy, is required to improve survival rates, 1,46 but further dose escalation fails to improve outcomes.…”