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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
  • 30 Downloads
Part of the following topical collections:
  1. Brain tumors

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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

Keywords

Glioblastoma Prognostic factors Neurologic performance 

Abbreviations

95CI

95% confidence interval

EANO

European Association of Neuro-Oncology

EOR

extent of resection

GBM

IDH-wild-type glioblastoma

HRQOL

health-related quality of life

HR

hazard ratio

KPS

Karnofsky performance scale

MGMT

O6-methylguanine DNA methyltransferase

MRC-NPS

medical research council neurological performance score

MRI

magnetic resonance imaging

OS

overall survival

RCx

radiochemotherapy

Rx

radiotherapy

PFS

progression-free survival

SD

standard deviation

Notes

Acknowledgements

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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