Abstract
BackgroundIDH-wild-type glioblastoma (GBM) is the most frequent brain-derived malignancy. Despite intense research efforts, it is still associated with a very poor prognosis. Several parameters were identified as prognostic, including general physical performance. In neuro-oncology (NO), special emphasis is put on focal deficits and cognitive (dys-)function. The Neurologic Assessment in Neuro-Oncology (NANO) scale was proposed in order to standardize the assessment of neurological performance in NO. This study evaluated whether NANO scale assessment provides prognostic information in a standardized collective of GBM patients.MethodsThe records of all GBM patients treated between 2014 and 2019 at our facility were retrospectively screened. Inclusion criteria were age over 18 years, at least 3 months postoperative follow-up, and preoperative and postoperative cranial magnetic resonance imaging. The NANO scale was assessed pre- and postoperatively as well as at 3 months follow-up. Univariate and multivariate survival analyses were carried to investigate the prognostic value.ResultsOne hundred and thirty-one patients were included. In univariate analysis, poor postoperative neurological performance (HR 1.13, p = 0.004), poor neurological performance at 3 months postsurgery (HR 1.37, p < 0.001), and neurological deterioration during follow-up (HR 1.38, p < 0.001), all assessed via the NANO scale, were associated with shorter survival. In multivariate analysis including other prognostic factors such as the extent of resection, adjuvant treatment regimen, or age, NANO scale assessment at 3 months postoperative follow-up was independently associated with survival prediction (HR 1.36, p < 0.001). The optimal NANO scale cutoff for patient stratification was 3.5 points.ConclusionNeurological performance assessment employing the NANO scale might provide prognostic information in patients suffering from GBM.
Highlights
IDH-wild-type glioblastoma (GBM) is the most common brainderived malignancy
This study evaluated whether Neurologic Assessment in Neuro-Oncology (NANO) scale assessment provides prognostic information in a standardized collective of GBM patients
Poor postoperative neurological performance (HR 1.13, p = 0.004), poor neurological performance at 3 months postsurgery (HR 1.37, p < 0.001), and neurological deterioration during follow-up (HR 1.38, p < 0.001), all assessed via the NANO scale, were associated with shorter survival
Summary
IDH-wild-type glioblastoma (GBM) is the most common brainderived malignancy. Due to its high mitotic activity, neoangiogenesis, and highly infiltrative behavior, it is classified as WHO grade four [1]. Several parameters were identified as influential on patient survival, including tumor location [5], extent of resection [6], age at date of diagnosis [7], O6-methylguanineDNA methyltransferase (MGMT) promoter methylation [8], and clinical performance [4]. In order to address this rising evidence and to standardize the evaluation of neurological performance, the Neurologic Assessment in Neuro-Oncology (NANO) scale was created [17]. This study was designed to evaluate the independent, prognostic value of neurological performance assessed via the NANO scale at different points of follow-up when the abovementioned clinical and radiological factors are considered within a standardized GBM patient collective. This study evaluated whether NANO scale assessment provides prognostic information in a standardized collective of GBM patients
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