BMC Neurology (Nov 2021)

Prognostic value of tumour volume in patients with a poor Karnofsky performance status scale – a bicentric retrospective study

  • Melanie Barz,
  • Julia Gerhardt,
  • Stefanie Bette,
  • A. Kaywan Aftahy,
  • Thomas Huber,
  • Stephanie E. Combs,
  • Yu-Mi Ryang,
  • Benedikt Wiestler,
  • Marco Skardelly,
  • Irina Gepfner-Tuma,
  • Felix Behling,
  • Friederike Schmidt-Graf,
  • Bernhard Meyer,
  • Jens Gempt

DOI
https://doi.org/10.1186/s12883-021-02424-0
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 10

Abstract

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Abstract Backround Median overall survival (OS) after diagnosis of glioblastoma (GBM) remains 15 months amongst patients receiving aggressive surgical resection, chemotherapy and irradiation. Treatment of patients with a poor preoperative Karnofsky Performance Status Scale (KPSS) is still controversial. Therefore, we retrospectively assessed the outcome after surgical treatment in patients with a KPSS of ≤60%. Methods We retrospectively included patients with a de-novo glioblastoma WHO °IV and preoperative KPSS ≤60%, who underwent surgery at two neurosurgical centres between September 2006 and March 2016. We recorded pre- and postoperative tumour volume, pre- and postoperative KPSS, OS, age and MGMT promoter status. Results One hundred twenty-three patients (58 females/65 males, mean age 67.4 ± 13.4 years) met the inclusion criteria. Seventy-five of the 123 patients (61%) underwent surgical resection. 48/123 patients (39%) received a biopsy. The median preoperative and postoperative tumour volume of all patients was 33.0 ± 31.3 cm3 (IR 15.0–56.5cm3) and 3.1 ± 23.8 cm3 (IR 0.2–15.0 cm3), respectively. The median KPSS was 60% (range 20–60%) preoperatively and 50% (range 0–80%) postoperatively. Patients who received a biopsy showed a median OS for patients who received a biopsy only was 3.0 months (95% CI 2.0–4.0 months), compared to patients who had a resection and had a median OS of 8 months (95% CI 3.1–12.9 months). Age (p < 0.001, HR: 1.045 [95% CI 1.022–1.068]), postoperative tumour volume (p = 0.02, HR: 1.016 [95% CI 1.002–1.029]) and MGMT promotor status (p = 0.016, HR: 0.473 [95% CI 0.257–0.871]) were statistically significant in multivariate analysis. In subgroup analyses only age was shown as a significant prognostic factor in multivariate analyses for patients receiving surgery (p < 0.001, HR: 1.046 [95% CI 1.022–1.072]). In the biopsy group no significant prognostic factors were shown in multivariate analysis. Conclusion GBM patients with a preoperative KPSS of ≤60% might profit from surgical reduction of tumour burden.

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