Prognostic Parameters in Malignant gliomas

Abstract

Aim: Despite recent advances in neuro-imaging, neurosurgieal techniques, and aggressive approach using combined modalities, the prognosis for patients with malignant gliomas remains dismal. The goal of this study was to increase our understanding of the relative influence that specific variables have on the outcome of patients. Methods and Materials: Forty-two patients with intracranial malignant gliomas (17 with anaplastic astrocytomas and 25 with glioblastoma multiforme), treated by surgery and postoperative radiotherapy at Mackay Memorial Hospital from April 1985 through April 1995, were retrospectively reviewed. Twenty-six men and 16 women with a median age of 44 years (range, 10 to 70 years) were entered in the study. Seventeen clinical factors (age at surgery; sex; initial presenting symptoms of headaches, mental changes, seizure, visual changes, motor deficits, sensory changes, and speech difficulties; preoperative performance status based on the Karnofsky scale; the extent of surgical removal; postoperative radiotherapy dose; the presence of brain edema, brain midline shift, and hematoma formation; tumor she; duration of initial symptoms), and 2 histological factors (histological grade; tumor cystic formation) were analyzed to investigate their importance in predicting length of survival. Data were analyzed using the Cox proportional harzards analysis or Chi-square test. Results: The overall median survival time was 18.7 months. The median survival time was 25.4 months for anaplastic astrocytoma and 14.2 months for glioblastoma multiforme Four pretreatment variables including histological grade, age, sex and the extent of tumor resection (subtotal or total) were found to have a statistically significant effect on survival when analyzed together by the Cox multivariate regression model. Univariate analysis by the Chi-square test identified the presenting neurological symptoms of mental changes and motor deficits as having an adverse effect on survival. Conclusions: The authors conclude that histological grade, age, sex, extent of tumor resection, and the presenting symptoms of mental changes or motor deficits were important prognostic parameters in malignant gliomas. By stratifying patients into more homogeneous subgroups with favorable or unfavorable prognostic factors, treatment can be specially tailored for different subgroups.