Scale to Predict Survival After Surgery for Recurrent Glioblastoma Multiforme

John K. Park,

From the Surgical and Molecular Neuro-oncology Unit, National Institute of Neurological Disorders and Stroke, Neuro-oncology Branch, National Cancer Institute, and National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD; and the Brigham and Women's Hospital, Boston, MA

Journal of Clinical Oncology, Vol 28, No 24 (August 20), 2010: pp. 3838-3843

Purpose Despite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.

Patients and Methods The preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. The factors associated with decreased postoperative survival (P < .05) were used to devise a prognostic scale which was validated with a separate cohort of 109 patients.

Results The factors associated with poor postoperative survival were:
tumor involvement of prespecified eloquent/critical brain regions (P = .021),
Karnofsky performance status (KPS) ≤ 80 (P = .030),
and tumor volume ≥ 50 cm3 (P = .048).

An additive scale (range, 0 to 3 points) comprised of these three variables distinguishes patients with good (0 points), intermediate (1 to 2 points), and poor (3 points) postoperative survival (median survival, 10.8, 4.5, and 1.0 months, respectively; P < .001). The scale identified three statistically distinct groups within the validation cohort as well (median survival, 9.2, 6.3, and 1.9 months, respectively; P < .001).

Conclusion We devised and validated a preoperative scale that identifies patients likely to have poor, intermediate, and good relative outcomes after surgical resection of a recurrent GBM tumor. Application of this simple scale may be useful in counseling patients regarding their treatment options and in designing clinical trials.