Artikel
Age-adjusted Charlson Comorbidity Index in recurrent glioblastoma – a new prognostic factor?
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Autoren
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Melanie Barz
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Stefanie Bette
- Technische Universität München, Klinikum rechts der Isar, Neuroradiologie, München, Deutschland
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Insa Janssen
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Yu-Mi Ryang
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Bernhard Meyer
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
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Jens Gempt
- Klinikum rechts der Isar, Technische Universität München, Neurochirurgische Klinik und Poliklinik, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
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Objective: Glioblastoma (GB) is the most common and aggressive primary brain tumor in adults. Almost all tumors show early recurrence and fatal outcome, despite aggressive therapy regimes. Several prognostic factors have been established, including age, Karnofsky Performance Score (KPS), extent of resection, and molecular markers.
This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent glioblastoma patients.
Methods: 133 patients from January 2007 until December 2016 (49 female, 84 male mean age 57 years (range 21–80 years), with surgery for a recurrent GB with available age-adjusted CCI (ACCI), including data about cardiovascular diseases and other relevant comorbidities were retrospectively included. Preoperative age, sex, ACCI, KPS and adjuvant treatment regimes were recorded for each patient. Extent of resection was assessed by manually segmented pre- and postoperative tumor volume.
Results: Median overall survival after initial diagnosis was 20.0 months (95% confidence interval (CI) 17.2-22.9)) and 9.0 months (95% CI 7.1-10.9 months) after first re-resection. In the case of first re-resection the preoperative KPS > 80% (P<0.001) and CCI <7 (P=0.020) were associated with significantly improved survival in univariate analysis.
For survival after first re-resection preoperative KPS (HR 1.741 [95% CI: 1.121-2.705], P=0.014) and extent of resection (HR 1.695 [95% CI: 1.096-2.621], P=0.018) were significant prognostic factors in multivariate analysis. CCI (HR 1.675 [95% CI: 0.834-3.364], P=0.147) and age (HR 0.915 [95% CI 0.590-1.44], P=0.704) did not show significant results. For survival after initial diagnosis preoperative CCI was significantly associated with improved survival (HR 2.006 [95% CI 1.013-3.971], P=0.046) as well as extent of resection (HR 1.613 [1.060-2.455], P=0.026).
Conclusion: ACCI might be an additional prognostic factor for patients with recurrent glioblastoma especially in patients with many comorbidities. However, besides the well-established KPS the ACCI does not add further information about patients’ prognosis.
