The prognostic value of peri-operative neurological performance in glioblastoma patients

  • Johannes DietterleEmail author
  • Tim Wende
  • Florian Wilhelmy
  • Christian Eisenlöffel
  • Katja Jähne
  • Sabine Taubenheim
  • Felix Arlt
  • Jürgen Meixensberger
Original Article - Brain Tumors
Part of the following topical collections:
  1. Brain tumors



IDH-wild-type glioblastoma (GBM) is a disease with devastating prognosis. First-line therapy consists of gross total resection and adjuvant radiotherapy with concomitant temozolomide. Several clinical parameters have been identified to provide prognostic value. We investigated whether peri-operative overall neurological performance could also be used to evaluate patients’ prognosis.


All patients with histologically diagnosed GBM between 2014 and 2017 over 18 years and MRI within 72 h after surgery were reviewed. To quantify neurological performance, the medical research council neurological performance score (MRC-NPS) was used. Univariate analysis with Kaplan–Meier estimate and log-rank test was performed. Survival prediction and multivariate analysis were performed employing Cox proportional hazard regression.


One hundred thirty-nine patients were included. In univariate analysis, survival decreased with increasing post-operative MRC-NPS scale. Moreover, post-operative MRC-NPS of 4 was statistically significant associated with reduced overall survival when analyzed for complete (p = 0.027) and partial resection (p = 0.002) as well as unilobar (p = 0.003) and multilobar tumor location (p < 0.0005). In multivariate analysis, extent of resection (hazard ratio (HR) 3.142), adjuvant therapy regimen (HR 3.001), tumor location (HR 2.005), and post-operative MRC-NPS (HR 2.310) had significant influence on overall survival.


We propose the post-operative neurological performance as an independent prognostic factor for GBM patients.


Glioblastoma Prognostic factors Neurologic performance 



95% confidence interval


European Association of Neuro-Oncology


extent of resection


IDH-wild-type glioblastoma


health-related quality of life


hazard ratio


Karnofsky performance scale


O6-methylguanine DNA methyltransferase


medical research council neurological performance score


magnetic resonance imaging


overall survival






progression-free survival


standard deviation



We acknowledge support from the German Research Foundation (DFG) and Leipzig University within the program of Open Access Publishing.

Author Contributions

Study design and data analysis: JD, JM, KJ, TW, FW; histopathological analysis: CE; date of death analysis: ST, JD; manuscript: JD, TW, FW, CE, JM, JM.

Compliance with ethical standards

Data collection and analysis were approved by the ethical committee of Medical Faculty, University of Leipzig (No. 102/19-ek), and carried out in accordance with data protection guidelines.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

701_2019_4136_MOESM1_ESM.pdf (42 kb)
ESM1 (PDF 41 kb)
701_2019_4136_MOESM2_ESM.pdf (76 kb)
ESM2 (PDF 75 kb)
701_2019_4136_MOESM3_ESM.pdf (164 kb)
ESM3 (PDF 163 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital LeipzigLeipzigGermany
  2. 2.Department of PathologyUniversity Hospital LeipzigLeipzigGermany
  3. 3.Leipzig Cancer RegistryUniversity Hospital LeipzigLeipzigGermany

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