Effect of pretreatment clinical factors on overall survival in glioblastoma multiforme: a Surveillance Epidemiology and End Results (SEER) population analysis

Sudheer R Thumma,Alexander R Mackay,Robert K Fairbanks,Wayne T Lamoreaux,Barton S Cooke,Ameer L Elaimy,Christopher M Lee,Peter W Hanson,John J Demakas

doi:10.1186/1477-7819-10-75

Abstract

BackgroundGlioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors and is associated with a dismal prognosis. The median survival after the primary diagnosis remains poor, even after multimodal treatment approaches. However, a few patients have been reported to have long term survival greater than three years. A number of studies have attempted to define factors capable of predicting long term outcomes in specific patient groups. This article reports the outcomes of a very large group of patients diagnosed with GBM, and analyzes specific prognostic factors known to influence survival in these patients.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database of the US National Cancer Institute (NCI) to investigate various patient-related and treatment- related factors that could influence the long term survival in patients diagnosed with glioblastoma. A total of 34,664 patients aged 20 years or older with a diagnosis of GBM during the years 1973 to 2008 were studied. Overall survival outcomes were examined with Kaplan-Meier survival analysis and Cox hazard models.ResultsAsian/Pacific Islanders had a better survival compared to the white population (P = <0.001). Patients diagnosed with GBM during the years 2000 to 2008 had a superior survival rate when compared with earlier decades (P = <0 .001). Statistically significant improvements in overall survival were also found for patients who received surgical resections, and adjuvant radiation treatment versus no radiation (P-values <0.001). Young age was also found to be highly predictive of improved overall survival rates when separated into age groups as well as when studied as a continuous variable.ConclusionsClinical pretreatment and treatment factors, including young age at diagnosis, Asian/Pacific Islander ethnicity, recent year of diagnosis, surgical resection and the use of adjuvant radiation therapy favorably influence survival in patients diagnosed with glioblastoma.Trial RegistrationAll data were obtained from the United States Surveillance Epidemiology and End Results (SEER) database.

Highlights

Glioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors and is associated with a dismal prognosis
We found that the clinical factors of age less than 50 years, Asian race, surgical resection of the tumor, adjuvant radiation treatment and recent diagnosis year from 2000 to 2008 correlated with improved survival
For every year increase in patient age, there was a significant decrease in survival, which is a unique finding in our study

Summary

Introduction

Glioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors and is associated with a dismal prognosis. Recent advances in the diagnostics and treatments of glioblastoma have offered new hope for patients and clinicians. Despite these advances in therapy, the management of glioblastoma remains a challenge. Tumor factors such as deep infiltration of cancer cells with microscopic extensions into surrounding normal brain tissue, geographic location within the brain and a particular tumor’s accessibility to surgical resection may present barriers to adequate surgical treatment. The addition of temozolamide has been shown to improve overall survival Despite this advance, the vast majority of patients still experience disease progression within a year [1]

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