Abstract
BackgroundFor recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients.MethodsIn this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21–80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part.ResultsMedian overall survival (OS) was 9.0 months (95% CI 7.1–10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246–3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036–2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses.ConclusionFor patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient’s prognosis besides the well-established KPSS and extent of resection.
Highlights
For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy
The Charlson comorbidity index (CCI) initially proved its worth in internal diseases, in recent studies it has proved to be a useful tool for tumour diseases in addition to the well-known and established Karnofsky Performance Status Scale (KPSS)
We retrospectively reviewed all the clinical data of these 123 patients and analyzed the comorbidities by using the age-adjusted adjusted Charl‐ son Comorbidity Index (ACCI) (Fig. 1)
Summary
For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. The (age-adjusted) CCI initially proved its worth in internal diseases, in recent studies it has proved to be a useful tool for tumour diseases in addition to the well-known and established KPSS. Initial steps in this direction have been taken by various workgroups in the case of relapsing tumors of different entities. The aim of this study was to evaluate patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor in recurrent GB
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