Ening G, Osterheld F, Capper D, Schmieder K, Brenke C
Department of Neurosurgery, Knappschafts-Krankenhaus Bochum-Langendreer, Ruhr-University of Bochum, In der Schornau 23-25, 44892, Bochum, Germany,
J Cancer Res Clin Oncol. 2015 Jun;141(6):1131-7. doi: 10.1007/s00432-014-1907-9. Epub 2015 Jan 11.
Dismal glioblastoma (GB) patient outcome calls for the elucidation of further reliable predictors of prognosis. Established "biomarkers," age and functional status, employed in today's patient stratification have limits in fingerprinting this heterogeneous tumor entity. We aimed at ascertaining additional prognostic factors that may facilitate patient stratification for surgery.
A retrospective review of 233 consecutive adult patients operated on for newly diagnosed GB at a single tertiary institution over a 5-year period (2006-2011) was conducted. Modern defined outcome associating factors recorded included demographics (preoperative age, gender, signs, symptoms, comorbidity status quantified by the Charlson comorbidity index (CCI), functional status computed by the Karnofsky performance scale (KPS)), tumor characteristics (size, location, isocitrate dehydrogenase mutation, and O-6-methylguanine-DNA methyltransferase promoter methylation status), and treatment parameters (volumetrically quantified extent of resection and adjuvant therapy). Survival analysis was performed by the Kaplan-Maier method. Influence of variables was evaluated using log-rank test.
Median neuroradiographic evidence of tumor progression was 6 months after surgery (range 0-72). The median overall survival was 9.5 months (range 0-72). Age > 65 years, KPS ≤ 70, and CCI > 3 were significantly associated with both poor OS (each p < 0.0001) and PFS (p < 0.0001, p < 0.001 and p < 0.002), respectively. Also, patients older than 65 years significantly had a CCI > 3 (p < 0.0001).
Our data evidence that aside established prognostic parameters (age and KPS) for GB patient outcome, the CCI additionally significantly impacts outcome and may be employed for preoperative patient stratification.
胶质母细胞瘤（GB）患者预后不佳，需要进一步阐明可靠的预后预测指标。目前用于患者分层的既定“生物标志物”——年龄和功能状态，在区分这种异质性肿瘤实体方面存在局限性。我们旨在确定可能有助于手术患者分层的其他预后因素。
对一家三级医疗机构在5年期间（2006 - 2011年）连续接受手术治疗的233例新诊断GB成年患者进行回顾性研究。记录的现代定义的结局相关因素包括人口统计学特征（术前年龄、性别、体征、症状、用查尔森合并症指数（CCI）量化的合并症状态、用卡诺夫斯基功能状态量表（KPS）计算的功能状态）、肿瘤特征（大小、位置、异柠檬酸脱氢酶突变以及O - 6 - 甲基鸟嘌呤 - DNA甲基转移酶启动子甲基化状态）和治疗参数（体积量化的切除范围和辅助治疗）。采用Kaplan - Meier法进行生存分析。使用对数秩检验评估变量的影响。
肿瘤进展的中位神经影像学证据出现在术后6个月（范围0 - 72个月）。中位总生存期为9.5个月（范围0 - 72个月）。年龄>65岁、KPS≤70以及CCI>3分别与较差的总生存期（各p<0.0001）和无进展生存期（p<0.0001、p<0.001和p<0.002）显著相关。此外，年龄大于65岁的患者CCI>3显著（p<0.0001）。
我们的数据表明，除了GB患者预后的既定预后参数（年龄和KPS）外，CCI还对结局有显著影响，可用于术前患者分层。
