Article
Do Patients with a poor Karnofsky performance scale profit from tumor volume reduction?
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Authors
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Julia Gerhardt
- Technische Universität München, Klinikum rechts der Isar, Abteilung für Neurochirurgie, München, Deutschland
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Stefanie Bette
- Technische Universität München, Klinikum rechts der Isar, Abteilung für Neuroradiologie, München, Deutschland
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Irina Gepfner-Tuma
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Marco Scardelly
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Felix Behling
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Yu-Mi Ryang
- Technische Universität München, Klinikum rechts der Isar, Abteilung für Neurochirurgie, München, Deutschland
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Bernhard Meyer
- Technische Universität München, Klinikum rechts der Isar, Abteilung für Neurochirurgie, München, Deutschland
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Jens Gempt
- Technische Universität München, Klinikum rechts der Isar, Abteilung für Neurochirurgie, München, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Median survival after diagnosis of glioblastoma remains 15 months among all patients with aggressive surgical resection, chemotherapy, and radiation. Treatment of patients with poor preoperative Karnofsky performance status (KPS) is still controversial. We therefore assessed retrospectively the outcome after surgical treatment in patients with KPS below 70%.
Methods: Patients with a new diagnosis of glioblastoma and preoperative KPS under 70%, who underwent surgical treatment in two different centers, were examined between September 2006 and March 2016. Pre- and postoperative tumor volume and KPS, overall survival, age and O6-Methylguanin-DNA-Methyltransferase (MGMT) status were recorded. Statistical analysis was performed with SPSS.
Results: We included 124 patients (58 female/ 66 male) with a mean age of 67 ± 14.2 years (12 - 90 years) who underwent surgical resection or biopsy of primary glioblastoma with a preoperative KPS of 60% and below. Median preoperative tumor volume was 33.0 cm3 (IR 15.2 - 57.1 cm3) preoperative and 3.1 cm3 (IR 0.2 - 15.0 cm3) postoperative. Complete resection of contrast enhancement in the postoperative MRI was achieved in 24 (19%) patients. Surgical resection with intent for maximal resection was performed in 76 (61%) patients (34/76 female and 72/76 male) and 48 (39%) patients (23/48 female, 25/48 male) underwent a biopsy. Median preoperative Karnofsky performance scale of all patients was 60% (20-60%) preoperative and 50% (0-80%) postoperative. Median overall survival was 123 days (IR 52.3 – 391.3 days). Surgical resection compared against biopsy (p<0.001) and complete resection of contrast enhancement (p=0.03) showed a significant impact on overall survival in univariate analysis using Kaplan-Meier estimates.
In the multivariate cox regression we found age time of surgery (p<0.001, HR: 1.045 [95% CI 1.022-1.068]), postoperative tumor volume (p=0.02, HR: 1.016 [95% CI 1.002-1.029]) and methylation status (p=0.016 HR: 0.473 [95% CI 0.257-0.871]) statistically significant concerning overall survival. Preoperative tumor volume (p=0.996, HR: 1.000 [95% CI 0.992-1.009]), preoperative KPS (p=0.068 HR: 1.023 [95% CI 0.998-1.049]) and postoperative KPS (p=0.237 HR: 0.987 [95% CI 0.965 -1.009]) were not significant in multivariate analysis.
Conclusion: Patients with preoperative KPS under 70% seem to profit from low postoperative tumor volume in MRI. Also preoperative tumor volume and age have significant predictors of overall survival in this patients’ cohort.
