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

• Published in: BMC neurology Vol. 21; no. 1; p. 446
• Main Authors: Barz, Melanie, Gerhardt, Julia, Bette, Stefanie, Aftahy, A Kaywan, Huber, Thomas, Combs, Stephanie E, Ryang, Yu-Mi, Wiestler, Benedikt, Skardelly, Marco, Gepfner-Tuma, Irina, Behling, Felix, Schmidt-Graf, Friederike, Meyer, Bernhard, Gempt, Jens
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 15-11-2021; BioMed Central; BMC
• Subjects: Age; Aged; Aged, 80 and over; Biopsy; Brain cancer; Brain Neoplasms - surgery; Care and treatment; Chemotherapy; Data analysis; EOR; Female; Glioblastoma; Glioblastoma - surgery; Glioblastoma multiforme; Humans; Interdisciplinary aspects; Karnofsky Performance Status; Karnofsky performance status scale; Magnetic resonance imaging; Male; Medical prognosis; Middle Aged; Multivariate analysis; Neurosurgery; Neurosurgical Procedures; Patients; Practice guidelines (Medicine); Prognosis; Retrospective Studies; Statistical analysis; Surgery; Survival analysis; Treatment Outcome; Tumor Burden; Tumors; Germany; EOR; Surgery; Glioblastoma; Karnofsky performance status scale
• ISSN: 1471-2377; 1471-2377
• DOI: 10.1186/s12883-021-02424-0

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%.
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.
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 cm
(IR 15.0-56.5cm
) and 3.1 ± 23.8 cm
(IR 0.2-15.0 cm
), 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.
GBM patients with a preoperative KPSS of ≤60% might profit from surgical reduction of tumour burden.