Artikel
Extent of surgical resection and quality of life in patients with glioblastoma multiforme
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Veröffentlicht: | 8. Juni 2016 |
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Gliederung
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Objective: Glioblastoma (GBM), the most common type of primary brain tumor, is currently graded by histopathological features. It is known that a higher extent of resection is correlated with longer survival. Besides, postoperative Karnofsky Performance Status (KPS), defining the quality of life, is also an important prognosticator for survival. Nevertheless, the expected quality of life often limits the extent of resection. The aim of the present study was to analyze the correlation of different surgical modalities and quality of life of patients suffering from GBM.
Method: All patients with primary glioblastoma multiforme operated at our institution between 2006 and 2014 were included in this survey. Possible surgical modalities were supratotal lobe resection (SLR), gross total resection (GTR, >95% by volume), tumor debulking (TDB, < 95% by volume), open surgical biopsy (OB) and stereotactic biopsy (SB). Pre- and postoperative KPS before and up to 4 weeks after surgery and overall survival rate (OS) were determined retrospectively. Statistical analyses were conducted using SPSS version 19.0.
Results: 565 patients were analyzed, comprising 324(57.3%) male and 241(42.7%) female patients with a median age of 62.2(0-84) years. Surgical modality comprised SLR in 21(3.7%), GTR in 234(41.4%), TDB in 122(21.6%), OB in 14(2.5%) and SB in 174(30.8%) patients. Mean pre- and postoperative KPS between surgical subgroups were 79% to 72% in SLR, 81% to 77% in GTR, 76% to 71% in TDB, 77% to 67% in OB and 76% to 74% in SB. No statistical significant difference of postoperative KPS decrease was found considering to the extension of surgery. Mean OS in months with standard deviation was 12.5 (± 15) and could be determined for 553 (97.9%) cases with 15(± 14.2) in STL, 17.1(± 16.3) in GTR, 11.8(± 12.9) in TDB, 9.1(± 8.9) in OB and 6.7(± 12.7) in SB. Surgical procedures without significant tumor reduction were associated with lower OS compared to the other surgical subgroups (p<0,05).
Conclusions: The results of the present study reveal that operative procedures facilitating a higher extent of resection are not correlated with a lower postoperative quality of life. Moreover, these patients gained higher survival rates. Whenever possible maximal resection should be considered in patients suffering from glioblastoma.