Abstract
Postoperative ischemia is associated with reduced functional independence measured by karnofsky performance score (KPS), which correlates well with overall survival. Other studies suggest that postoperative hypoxia might initiate infiltrative tumor growth. Therefore, aim of this study was to analyze the impact of infarct volume on overall survival and progression free survival (PFS) of glioblastoma patients.251 patients with surgery for a newly diagnosed glioblastoma (WHO IV) were retrospectively assessed. Pre- and postoperative KPS, date of death/last follow-up and histopathological markers were recorded. Pre- and postoperative tumor volume and the volume of postoperative infarction were manually segmented.A significant correlation of infarct volume with postoperative KPS decrease (P = 0.001) was observed. Infarct volume showed a significant impact on overall survival (P = 0.014), but not on PFS (P = 0.112) in univariate analysis. This effect increased in the subgroup of patients with near-total tumor resection (> 90%) (overall survival: P = 0.006, PFS: P = 0.066). Infarct volume remained as an independent prognostic factor for overall survival in multivariate analysis (HR 1.013 [1.000–1.026], P = 0.042) including other prognostic factors (age, extent of resection, postoperative KPS).Postoperative infarct volume significantly correlates as an independent factor with overall survival after glioblastoma surgery. Besides the influence of perioperative infarction on postoperative KPS, postoperative hypoxia might also have an effect on tumor biology initiating infiltrative growth and therefore impaired survival.
Highlights
Glioblastoma (GB) is the most frequent malignant brain tumor in adults and, despite recent advances in therapy, still has a poor overall survival with a 5-year survival rate of only 5% [1, 2]
Postoperative ischemia is associated with reduced functional independence measured by karnofsky performance score (KPS), which correlates well with overall survival
Studies showed that impaired postoperative KPS and new postoperative neurological deficits caused by ischemic changes are associated with shorter overall survival [16, 17]
Summary
Glioblastoma (GB) is the most frequent malignant brain tumor in adults and, despite recent advances in therapy, still has a poor overall survival with a 5-year survival rate of only 5% [1, 2]. Karnofsky performance score (KPS) is an important prognostic factor for patients with www.impactjournals.com/oncotarget glioblastoma and is routinely used to assess the functional independence of tumor patients perioperatively and on follow-up examinations [12,13,14]. Studies showed that impaired postoperative KPS and new postoperative neurological deficits caused by ischemic changes are associated with shorter overall survival [16, 17]. Another recent study showed that postoperative ischemia was associated with a diffuse tumor recurrence pattern, which showed no correlation to overall survival in this patient cohort but suggests hypoxia as a factor for tumor growth [18]
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