Low Karnofsky Performance Scale Research Articles

Surgical treatment of pituitary neuroendocrine tumors with coexisting intracranial lesions: A case series and review of the literature.

Pituitary neuroendocrine tumors (PitNETs) are a diverse group of benign neoplasms that account for a significant proportion of intracranial tumors (13%). The coexistence of PitNET with other intracranial lesions, such as meningiomas and intracranial aneurysms, has been constantly reported in the literature; yet, the pathophysiological mechanisms remain unknown, and the appropriate management is controversial. This study aims to describe the clinical characteristics, surgical treatment, and outcomes of patients with PitNET with coexisting intracranial lesions in a single healthcare center. A retrospective analysis was conducted on 12 patients who underwent surgical treatment for PitNET and another intracranial lesion at our single tertiary referral center over 15 years from January 2008 to May 2023. Among these coexisting lesions, aneurysms were the most commonly found (41.67%), followed by meningiomas (33.33%). Surgical intervention for both lesions was performed in a single-stage procedure for most cases (75%), employing transcranial, endoscopic endonasal, and combined approaches. We found low preoperative Karnofsky Performance Scale scores in three patients, with significant differences in functional outcomes. These findings contribute to the limited knowledge about PitNET coexisting with other intracranial lesions and emphasize the importance of patient-tailored, multidisciplinary management in these unusual scenarios.

Impact of Demographic Characteristics on Self-Reported Psychological Distress of Cancer Patients during the COVID-19 Pandemic

Purpose/Objective(s)To investigate how at-risk demographic features correlate with the perceived level of psychological distress in cancer patients actively receiving care during the COVID-19 pandemic.Materials/MethodsPatients treated with radiotherapy at a single academic cancer center were reviewed 3 months before (11/01/2019-03/16/2020) and during (03/17/2020- 2/01/2021) the COVID-19 pandemic. Patients who reported an NCCN distress score (range 0=no distress to 10=extreme distress) as a part of their radiation care were reviewed for inclusion. Variables of interest were extracted from the medical record including age, gender, ethnicity, and Karnofsky Performance Scale (KPS) score. Distress scores were recorded around the time of simulation or treatment start. The relationship between these variables and NCCN distress scores were assessed using univariate and multivariate linear regression.ResultsOf all the patients receiving active treatment during the study interval (n=3,129), a total of 2,012 patients reported distress scores and thus were included. Median pre-pandemic distress was 3 (Interquartile Range 0-5) compared to median score of 2 (IQR 0-4) during the pandemic. There was no change in pre- and during pandemic distress on subgroup analysis by age, gender, ethnicity, or KPS score. The following variables were significantly correlated with increased distress on univariate analysis: older age (beta-age = -0.0163 [95% CI: -0.0262 to -0.0063], female gender (OR = 2.43 [95% CI 1.88 to 3.03], race (“black” race OR = 2.77 [95% CI: 1.68 to 4.57] and “other” race OR 1.96 [95% CI: 1.34-2.83]) and lower KPS score (beta-KPS = -0.403 [95% CI: -0.509 to -0.298]. Multivariate analysis was used to test if these demographic features were correlated with psychological distress among all patients. The overall regression was statistically significant albeit with a small effect size (R2=0.0605, p < .0001). On multivariate analysis, the following variables remained significant: age (beta-age = -0.0145 [95% CI: -0.0266 to -0.00241]), KPS score (beta-KPS = -0.429 [95% CI: -0.561 to -0.297]), and female gender (OR = 1.88 [95% CI: 1.28-2.75]).ConclusionThe ongoing COVID-19 pandemic did not significantly affect patient-reported distress levels at the time of receiving cancer-directed therapy. Older age, female gender, and low KPS score were associated with higher psychological distress in cancer patients receiving radiotherapy. Current analysis reveals vulnerable populations of cancer patients may have higher risk of distress during radiotherapy. These populations would warrant additional surveillance during treatment and may benefit from additional psychosocial support.

Clinical outcome and complication of anterior cranial Fossa meningiomas in tertiary care Hospital Peshawar

Objectives: We examined the surgical outcome and complications of anterior cranial Fossa meningiomas. Materials and Methods: A prospective study was conducted at the Department of Neurosurgery Prime Teaching Hospital, Peshawar, KPK, Pakistan from June 2019 to June 2021. A total of 31 patients were selected through non-probability consecutive sampling. After clinical examination and radiological findings, the patients were diagnosed with anterior cranial Fossa meningiomas. Microsurgical Trans cranial approaches did. Clinical outcomes and complications were documented. Tumor anterior cranial fossa meningiomas. A low Karnofsky performance scale index was used to analyze the functional impairment of the patients. Results: 9 (29.03%) were male and 22 (70.96%) patients were female. The mean age of presentation was 42 ± 5 years. Headache 25 (80.6%) and Visual loss were the main presenting symptoms 24 (77.5%), and Tuberculum sellae meningioma patients 08 (25.08%). The most common approach was Bifrontal craniotomy for OGM in 9 patients and two small OGM were operated on utilizing frontolateral craniotomy. The rest of the cases were operated through Pterional craniotomy. Tuberculamsalle meningiomas surgery results in a visual improvement in 6 patients (75%), Complete tumor resection was achieved in 22 (70.9%) patients and subtotal resection is achieved in 6 (19.3%) patients. In a few patients 03 (9.67%) only safe debulking and biopsy were taken. Postoperative hemorrhage was in 4 (12.9%) patients. Conclusion: Transcranial approach for microsurgical resection of anterior cranial fossa meningiomas is an effective and feasible approach in terms of visual outcome and extent of resection. Keywords: Anterior cranial Fossa Meningioma, Bifrontal Craniotomy, Front-lateral craniotomy.

Discrepancies between frame- and CBCT-based stereotactic space definition on the Gamma Knife Icon.

PurposeTo assess differences between frame‐based and cone beam computed tomography (CBCT)‐defined stereotactic space and to identify predictors of the observed findings.Methods and materialsDifferences between frame‐based and CBCT‐defined stereotactic space after image co‐registration were reviewed for 529 patients. Treatment planning system reported the information about the shifts in X, Y, and Z coordinates of the center of the stereotactic space (i.e., coordinate X = 100 mm, Y = 100 mm, and Z = 100 mm) defined by the frame, and the maximum shot displacement (MSD) in mm. We collected the potential predictors of the differences. In total, 19 factors were investigated. We used multiple linear regression to evaluate associations with the increased differences.ResultsRotational and translational shifts greater than 1° and 1 mm, respectively, were observed in 2.6% of patients. At the same time, a decrease in tumor coverage of more than 5% was detected in 8.3% of cases. It was revealed that the higher fiducial errors (both mean and maximum), the greater weight of the patient, and the lower Karnofsky Performance Scale were predictors of increased rotational, translational shifts, and the MSD.

Distinct Phenotypes of Kidney Transplant Recipients in the United States with Limited Functional Status as Identified through Machine Learning Consensus Clustering.

Background: There have been concerns regarding increased perioperative mortality, length of hospital stay, and rates of graft loss in kidney transplant recipients with functional limitations. The application of machine learning consensus clustering approach may provide a novel understanding of unique phenotypes of functionally limited kidney transplant recipients with distinct outcomes in order to identify strategies to improve outcomes. Methods: Consensus cluster analysis was performed based on recipient-, donor-, and transplant-related characteristics in 3205 functionally limited kidney transplant recipients (Karnofsky Performance Scale (KPS) < 40% at transplant) in the OPTN/UNOS database from 2010 to 2019. Each cluster’s key characteristics were identified using the standardized mean difference. Posttransplant outcomes, including death-censored graft failure, patient death, and acute allograft rejection were compared among the clusters Results: Consensus cluster analysis identified two distinct clusters that best represented the clinical characteristics of kidney transplant recipients with limited functional status prior to transplant. Cluster 1 patients were older in age and were more likely to receive deceased donor kidney transplant with a higher number of HLA mismatches. In contrast, cluster 2 patients were younger, had shorter dialysis duration, were more likely to be retransplants, and were more likely to receive living donor kidney transplants from HLA mismatched donors. As such, cluster 2 recipients had a higher PRA, less cold ischemia time, and lower proportion of machine-perfused kidneys. Despite having a low KPS, 5-year patient survival was 79.1 and 83.9% for clusters 1 and 2; 5-year death-censored graft survival was 86.9 and 91.9%. Cluster 1 had lower death-censored graft survival and patient survival but higher acute rejection, compared to cluster 2. Conclusion: Our study used an unsupervised machine learning approach to characterize kidney transplant recipients with limited functional status into two clinically distinct clusters with differing posttransplant outcomes.

Impact of race on nonroutine discharge, length of stay, and postoperative complications after surgery for spinal metastases.

Previous studies have suggested the possibility of racial disparities in surgical outcomes for patients undergoing spine surgery, although this has not been thoroughly investigated in those with spinal metastases. Given the increasing prevalence of spinal metastases requiring intervention, knowledge about potential discrepancies in outcomes would benefit overall patient care. The objective in the present study was to investigate whether race was an independent predictor of postoperative complications, nonroutine discharge, and prolonged length of stay (LOS) after surgery for spinal metastasis. The authors retrospectively examined patients at a single comprehensive cancer center who had undergone surgery for spinal metastasis between April 2013 and April 2020. Demographic information, primary pathology, preoperative clinical characteristics, and operative outcomes were collected. Factors achieving p values < 0.15 on univariate regression were entered into a stepwise multivariable logistic regression to generate predictive models. Nonroutine discharge was defined as a nonhome discharge destination and prolonged LOS was defined as LOS greater than the 75th percentile for the entire cohort. Three hundred twenty-eight patients who had undergone 348 operations were included: 240 (69.0%) White and 108 (31.0%) Black. On univariable analysis, cohorts significantly differed in age (p = 0.02), marital status (p < 0.001), insurance status (p = 0.03), income quartile (p = 0.02), primary tumor type (p = 0.04), and preoperative Karnofsky Performance Scale (KPS) score (p < 0.001). On multivariable analysis, race was an independent predictor for nonroutine discharge: Black patients had significantly higher odds of nonroutine discharge than White patients (adjusted odds ratio [AOR] 2.24, 95% confidence interval [CI] 1.28-3.92, p = 0.005). Older age (AOR 1.06 per year, 95% CI 1.03-1.09, p < 0.001), preoperative KPS score ≤ 70 (AOR 3.30, 95% CI 1.93-5.65, p < 0.001), preoperative Frankel grade A-C (AOR 3.48, 95% CI 1.17-10.3, p = 0.02), insurance status (p = 0.005), being unmarried (AOR 0.58, 95% CI 0.35-0.97, p = 0.04), number of levels (AOR 1.17 per level, 95% CI 1.05-1.31, p = 0.004), and thoracic involvement (AOR 1.71, 95% CI 1.02-2.88, p = 0.04) were also predictive of nonroutine discharge. However, race was not independently predictive of postoperative complications or prolonged LOS. Higher Charlson Comorbidity Index (AOR 1.22 per point, 95% CI 1.04-1.43, p = 0.01), low preoperative KPS score (AOR 1.84, 95% CI 1.16-2.92, p = 0.01), and number of levels (AOR 1.15 per level, 95% CI 1.05-1.27, p = 0.004) were predictive of complications, while insurance status (p = 0.05), income quartile (p = 0.01), low preoperative KPS score (AOR 1.64, 95% CI 1.03-2.72, p = 0.05), and number of levels (AOR 1.16 per level, 95% CI 1.05-1.30, p = 0.004) were predictive of prolonged LOS. Race, insurance status, age, baseline functional status, and marital status were all independently associated with nonroutine discharge. This suggests that a combination of socioeconomic factors and functional status, rather than medical comorbidities, may best predict postdischarge disposition in patients treated for spinal metastases. Further investigation in a prospective cohort is merited.

Association of Modified Geriatric Nutrition Risk Index and Handgrip Strength With Survival in Cancer: A Multi-Centre Cohort Study.

BackgroundThis study aimed to explore the value of combining the modified geriatric nutrition risk index (mGNRI) and handgrip strength (HGS) in the prognosis assessment of cancer.MethodsThis multicenter, prospective cohort study, enrolled 5,607 cancer patients from 27 medical centers across 17 provinces in China between June 2012 and December 2019. The primary outcome was overall survival. Secondary outcomes included the Karnofsky Performance Scale (KPS) score, Patient-Generated Subjective Global Assessment (PG-SGA) score, cachexia, and admission 90-day outcome. A composite prognostic score (mGNRI-HGS score) was developed based on the mGNRI and HGS. The Kaplan–Meier method was used to draw the survival curve, and log-rank analysis was used to estimate the survival rate. The Cox proportional hazards model was used to investigate the associations of the mGNRI, HGS or mGNRI-HGS score with risk of mortality among the cancer patients, adjusted for potential confounders.ResultsA low mGNRI (HR = 0.99, 95%CI = 0.98–0.99, p < 0.001) and low HGS (HR = 0.99, 95%CI = 0.98–0.99, p = 0.001) were associated with an increased risk of mortality. A severe mGNRI-HGS score was independently associated with reduced survival. Compared with patients with normal scores, the risk of mortality among the patients with moderate and severe mGNRI-HGS scores was 28.8 and 13.3% higher, respectively. Even within the same pathological stage, it presented significant gradient prognostic stratification. Additionally, a low mGNRI-HGS score was also independently associated with a higher risk of low KPS (p < 0.001), high PGSGA (p < 0.001), cachexia (p < 0.001), and adverse admission 90-day outcome (p < 0.001).ConclusionsThe mGNRI and HGS may be useful predictors of long-term prognosis in cancer patients. The combination of the two methods provides effective prognostic stratification for cancer patients and could predict physical frailty, malnutrition, and cachexia.

Survival Benefit from Surgical Resection in Lung Cancer Patients with Brain Metastases: a Single-Center, Propensity-Matched Analysis Cohort Study.

Brain metastases (BMs) are the most serious complication of lung cancer, affecting the prognosis of lung cancer patients, and pose distinct clinical challenges. This study was designed to explore the prognostic factors related to lung cancer BM and the value of surgical resection in BMs from lung cancer. A retrospective analysis was performed on 714 patients with lung cancer BMs screened between January 2010 and January 2018 at the Sun Yat-sen University Cancer Center. A 1:1 propensity score matching analysis was performed to reduce the potential bias between the surgery and the nonsurgery group. In both the raw and the propensity-score matched dataset, univariate and multivariate Cox proportional hazards regression analyses were used to evaluate risk factors for survival. After matching, 258 patients (129 surgery, 129 no surgery) were analyzed. Multivariate analyses after propensity score matching demonstrated that surgical resection was an independent protective factor for overall survival (OS), and older age, lower Karnofsky Performance Scale (KPS) score, and extracranial metastases were independent risk factors for worse OS. Patients without extracranial metastases, without synchronous BM and with a single BM had a better prognosis. The findings showed that surgical resection, age, KPS score, and extracranial metastases are independent prognostic factors for predicting the OS of patients with lung cancer BMs, and surgical resection for brain metastatic lesions could significantly improve the OS. However, only certain groups of patients with BMs can benefit from intracranial lesion resection, such as no extracranial metastases and metachronous metastases.

BIOM-29. ASSOCIATION OF PLASMA microRNA-21 EXPRESSION WITH KARNOFSKY PERFORMANCE SCALE SCORES IN GLIOMA PATIENTS

Abstract Gliomas are one of the most common primary brain tumors. MicroRNA-21 (miRNA-21) has been shown in previous studies to be associated with prognosis in glioma patients. However, similar studies in the Asian population, particularly in Indonesia, are very limited. This study aimed to find the association of plasma miRNA-21 expression with functional status measured by Karnofsky Performance Scale (KPS) in Indonesian glioma patients. The patients were enrolled from a neuro-oncology referral center in Yogyakarta, Indonesia. MiRNA-21 expression from plasma was measured by real-time quantitative PCR. Clinical data were obtained from medical records. KPS scores were classified as low (&amp;lt; 70) and high (&amp;gt; 70). In total, 50 patients were included in this study. Most patients were diagnosed with WHO grade IV gliomas (30.4%), followed by grade II (30.4%), grade III (21.4%), and grade I (5.4%). Most patients (64%) have low KPS scores (&amp;lt; 70). Patients in the low KPS scores group have significantly higher miRNA-21 expression compared to patients in the high KPS scores group (2-∆CT 4.26 vs. 0.68, p=0.002). In conclusion, higher expression of plasma miRNA-21 is associated with worse functional status in glioma patients as measured by KPS.

Outcomes following head and neck cancer surgery among older adults as determined by an electronic geriatric assessment

PurposeOlder adults with head and neck cancer have increased postoperative complications, longer hospital stays, and higher rates of mortality. Geriatric assessment (GA) provides a measure of overall health status and is preferable to using age alone for assessing fitness for surgery. We sought to determine whether a patient's frailty as determined by a novel electronic GA is associated with outcomes after head and neck cancer (HNC) surgery. MethodsWe conducted a retrospective review of 159 patients aged 75 and older referred to the Geriatrics Service at Memorial Sloan Kettering Cancer Center for pre-operative evaluation prior to undergoing HNC surgery. All patients completed the electronic Rapid Fitness Assessment (eRFA) within 60 days prior to surgery. The accumulated geriatric deficit (AGD) score includes twelve domains from the eRFA with a point assigned for each domain in which there is a deficit and a final point related to comorbidities. Three other metrics were individually assessed: age, Karnofsky Performance Scale (KPS), and number of comorbidities. We utilized multivariable linear regression and t-tests to determine whether frailty is associated with longer length of hospital stay, 30-day intensive care unit (ICU) admission, and 30-day and 90-day postoperative mortality. ResultsPatients with a higher AGD score spent more time in the hospital post-operatively (1.0 day increase per unit increase in AGD; 95% CI: 0.21–1.9; p = 0.015). Lower KPS was also associated with statistically significant longer length of stay (−2.70 day change per increasing index KPS; 95% CI: −4.30 – −1.00; days; p = 0.002), while age and comorbidity were not found to be statistically associated with length of stay. Higher AGD score remained significantly associated with longer length of stay on multivariable analysis (0.93 day increase per unit increase in AGD; 95% CI 0.15–1.71; p = 0.019). AGD was the only metric associated with increased risk of ICU admission (6.6 vs 5.0 geriatric deficits for those admitted vs not admitted to ICU; p = 0.024). ConclusionsFrailty is associated with increased length of hospital stay and ICU admission in older adults with HNC undergoing surgery. GA can be used to counsel patients on the expected postoperative course.

O6-Methylguanine-DNA Methyltransferase (MGMT) promoter methylation status of high-grade and low-grade gliomas

Background: O6-methylguanine-DNA methyltransferase (MGMT) is a DNA-repair enzyme that correlates with tumor resistance mechanism to chemotherapy. Methylation of the MGMT promoter inhibits the cells from producing MGMT and is useful to predict chemotherapy's effectiveness with alkylating agents. This study aims to evaluate the MGMT promoter methylation of low-grade and high-grade glioma in the Neurosurgery Department of Cipto Mangunkusumo National General HospitalMethods: We evaluated MGMT promoter methylation status using methylation-specific polymerase chain reaction in low and high-grade glioma patients who underwent surgical resection in the Neurosurgery Department of Cipto Mangunkusomo Hospital Jakarta. The result then correlated with age, sex, Karnofsky Performance Scale (KPS), and glioma grading. Data were analyzed using SPSS version 20 for Windows.Results: MGMT promoter methylation was observed more often in patients diagnosed with age more than 40 years old than in patients less than 40 years old (85.7% vs. 50.0%), also more in men than women (77.7% vs. 50.0%). In patients with KPS more than 70 and KPS 70 or less, methylation of MGMT promoter was observed in 70.0% and 57.1%, respectively. Based on tumor grading, MGMT promoter methylation was observed more often in low-grade gliomas (WHO grade II) than high-grade gliomas (WHO grade II and IV) (85.7% vs. 50.0%). There was no significant relationship between gender, age, KPS, malignancy degree, and Overall Survival (OS) to the MGMT promoter methylation (p&gt;0.05).Conclusion: MGMT promoter methylation was observed less in the higher grade of tumors (grade IV), lower KPS, younger age at the time of diagnosis, and female patients, although the differences were not statistically significant. MGMT promoter methylation was observed more often in gliomas with oligodendroglioma components.

Clinical significance of interleukin-10 concentration in the cerebrospinal fluid of patients with primary central nervous system lymphoma.

The diagnostic and prognostic evaluation of primary central nervous system lymphoma (PCNSL) is challenging due to the lack of sensitive biomarkers. The present study aimed to evaluate the value of interleukin (IL)-10 in this context. Between October 2016 and December 2018, 91 patients with suspected intracranial neoplasms were recruited, and the concentrations of IL-10 or IL-6 in both the cerebrospinal fluid (CSF) and blood were measured and analyzed by the Kruskal-Wallis test. The correlation between CSF IL-6 or IL-10 levels and tumor size was determined by Spearman's coefficient analysis. The receiver operating characteristic curve was used to evaluate the diagnostic value of CSF IL-6 and IL-10 levels. Median progression-free survival (PFS) and overall survival time were calculated using Kaplan-Meier survival analysis. Among the 91 patients, 3 were diagnosed with PCNSL on the basis of neuroimaging data and CSF IL-10 levels. A total of 35 cases were verified to show diffuse large B-cell lymphoma on histological assessment, 17 of which were diagnosed as PCNSL by MRI. The median PFS and OS were 8.00 months [95% confidence interval (CI), 3.94–12.06) and 17.5 months (95% CI, 11.55–23.45) respectively in the 12 PNCSL cases with regular follow up. The diagnostic efficiency of serum IL-6 levels was lower than that of serum IL-10 levels (P=0.030), which, in turn, was lower than that of CSF IL-10 levels (P<0.001). The decline and increase in CSF IL-10 levels was concurrent with improvement and deterioration in manifestation, respectively, which predated the MRI variation. High CSF IL-10 levels indicated low Karnofsky performance scale scores and shortened PFS times. CSF IL-10 levels higher than 1,000 pg/ml signified disease progression. CSF IL-10 levels could be a sensitive biomarker guiding the differential diagnosis, early recurrence detection, prognostic evaluation and therapeutic strategy establishment in cases of PCNSL.

The prognostic value of prognostic nutritional index (PNI) and neutrophil to lymphocyte ratio (NLR) for advanced non-small cell lung cancer treated with platinum-based chemotherapeutics

The present study aimed to investigate the relationship between prognostic nutritional index (PNI) and peripheral blood neutrophil to lymphocyte ratio (NLR), and the prognosis of patients with advanced non-small cell lung cancer (NSCLC) treated with platinum-based therapeutics. The data of 99 advanced NSCLC patients treated with platinum chemotherapeutics between January 2011 and June 2019 were retrospectively analyzed. The association between PNI and NLR and the clinicopathological characteristics of the patients was examined. The patients were randomized into high or low groups according to PNI and NLR. The predictive value of PNI and NLR for overall survival (OS) was evaluated by receiver operating characteristic (ROC) curve analysis. Univariate and multivariate Cox proportional hazards regression analyses were performed to investigate the prognostic factors of advanced NSCLC patients treated with platinum-based chemotherapeutics. The association between PNI and NLR and progression-free survival (PFS) or OS was determined using the Kaplan-Meier method and compared between groups using the log-rank test. The ROC curve analysis determined the optimal cut-off values of PNI and NLR for predicting OS to be 52.525 and 3.525, respectively. Univariate analysis indicated that low Karnofsky performance scale (KPS) score (P=0.005), poor tumor differentiation (P=0.022), brain metastasis (P<0.001), and low PNI (P=0.001) were independent risk factors for PFS in patients with advanced NSCLC; however, there was no significant correlation observed between NLR (P=0.082) and PFS in patients with advanced NSCLC. Low KPS score (P=0.003), poor tumor differentiation (P=0.001), brain metastasis (P<0.001), low PNI (P<0.001), and high NLR (P=0.046) were significantly associated with shorter OS. Furthermore, Cox multivariate analysis revealed that brain metastasis (P=0.005) and low PNI (P=0.008) were significant independent prognostic factors for PFS, while brain metastasis (P=0.003) and low PNI (P=0.028) were also found to be significant independent risk factors for poor OS. PNI is a reliable, simple, easily available, and inexpensive biomarker for predicting the prognosis of advanced NSCLC patients treated with platinum-based chemotherapeutics in routine clinical practice. Furthermore, PNI is superior to NLR in as a prognostic indicator for advanced NSCLC patients treated with platinum-based chemotherapeutics.

Impact of preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma undergoing repeated operation

Objective:The objective of this study was to document the impact of the preoperative Karnofsky Performance Scale (KPS) and American Society of Anesthesiologists (ASA) scores on perioperative complications in patients with recurrent glioma who underwent tumor resection via craniotomy.Methods:A total of 96 patients were retrospectively reviewed. Based on KPS and ASA scores, patients were categorized into high KPS (&gt; 70) or low KPS (≤ 70) and high ASA (3~4) or low ASA (1~2) groups. Differences in intraoperative risk factors and perioperative complications among the groups were analyzed. Multivariate analysis was performed to identify risk factors for perioperative complications.Results:The most frequent perioperative complications were cerebrospinal fluid leakage (31.8%) and intracranial infection (27.0%); 30-day mortality was 5.2%. The incidence rates of severe complications, central nervous system complications, and total complications were comparable in the low and high KPS groups and in the low and high ASA groups (all p &gt; 0.05). Multivariate analysis showed that low KPS and high ASA scores were not the independent risk factors for perioperative complications.Conclusion:Low KPS and high ASA scores are not associated with increased postoperative complications in patients with recurrent glioma who undergo tumor resection via craniotomy.

MiR-145 is a potential biomarker for predicting clinical outcome in glioblastomas.

miR-145 has been found to be significantly downregulated in gliomas, and overexpression of miR-145 increases glioma cell apoptosis and enhances chemosensitivity or herpes simplex virus thymidine kinase gene therapy. However, the correlation between miR-145 and the clinical prognosis of glioblastomas has never been explored. In this study, a retrospective study was conducted in 86 cases of patients with glioblastoma after neurosurgery combined with chemoradiotherapy, and 36 cases with traumatic brain injury. Our results showed that miR-145 was significantly lower in glioblastoma tissues than that in normal brain tissue (P < 0.05). Furthermore, miR-145 was lower in patients with lower Karnofsky Performance Scale (KPS) scores than in patients with higher KPS scores ( P < 0.05). Cox Regression analysis showed that low miR-145 expression was associated with poor patient survival ( P < 0.05). These data suggested that patients with glioblastoma with lower miR-145 expression are prone to shorter overall survival.

Stereotactic Shifts During Frame-Based Image-Guided Stereotactic Radiosurgery: Clinical Measurements

To determine the magnitude and reason for discrepancies between frame- and cone beam computed tomography (CBCT)-determined stereotactic coordinates, we reviewed frame-based Gamma Knife radiosurgery procedures in which CBCT was performed before treatment. Clinical and treatment documentation was reviewed for 150 frame placements for which stereotactic coordinates were defined via both frame and fiducials on computed tomography imaging and CBCT. Treatment planning system-reported rotational and translational differences and standard deviations (SDs) between frame-based and CBCT-based stereotactic coordinates were recorded. Potential clinical predictors for increased differences were collected. Multiple linear regressions were performed to evaluate for associations with increased translations and rotations. The absolute mean of the measured pitch, yaw, and roll shifts was 0.14 degrees (range -0.71-0.63 degrees, SD 0.19 degrees), 0.16 degrees (range -0.50 to 0.83 degrees, SD 0.21 degrees), and 0.12 degrees (range 0.37-0.51 degrees, SD 0.15 degrees), respectively. The absolute mean of the measured shifts in the left-right, anteroposterior, and superior-inferior direction was 0.29mm (range -1.29 to 0.82mm, SD 0.35mm), 0.24mm (range -0.59 to 0.33mm, SD 0.19mm), and 0.24mm (range -0.69 to 0.91mm, SD 0.27mm), respectively. Three cases (2.0%) exceeded 1mm in translational difference, all in the left-right direction (1.05, 1.13, and 1.29mm). Lower Karnofsky Performance Scale status was associated with greater translational differences (vector magnitude, P=.023) and rotation (pitch, P=.044; yaw, P=.002). Usage of longer total pin length (sum of all 4 fixation pin lengths) was associated with increased rotation but not with translation (P<.001 and P=.56, respectively). CBCT imaging in this cohort of frame-based cases suggests that the discrepancy in stereotactic coordinates is less than 1mm or degree in most cases. Low Karnofsky Performance Scale status and longer total pin length correlate with larger differences between frame-defined and CBCT-defined stereotactic coordinates.

14-3-3β exerts glioma-promoting effects and is associated with malignant progression and poor prognosis in patients with glioma.

Glioma is a type of tumor that affects the central nervous system. It has been demonstrated that 14-3-3β, a protein that is mainly concentrated in the brain, serves an important role in tumor regulation. However, the mechanism of action of 14-3-3β that underlies the pathogenesis of glioma remains to be elucidated. In the present study, 14-3-3β was silenced by RNA interference in the human glioma cell line U373-MG. Following knockdown of 14-3-3β, the proliferation, colony formation, cell cycle progression, migration and invasion of U373-MG cells were significantly decreased (P<0.01), whereas cell apoptosis was increased (P<0.01). Furthermore, in a tumor xenograft experiment, silencing 14-3-3β significantly inhibited the in vivo tumor growth of U373-MG cells (P<0.01). The results demonstrated that 14-3-3β levels were significantly higher in human glioma tissues compared with normal brain tissues (P<0.01) and high 14-3-3β expression was significantly associated with advanced pathological grade (P<0.03) and low Karnofsky performance scale (P<0.003). Patients with glioma who had high 14-3-3β levels had a significantly shorter survival time compared with those with low expression of 14-3-3β (P=0.031), suggesting that 14-3-3β may be an effective predictor of the prognosis of patients with glioma. The results of the present study indicate that 14-3-3β serves an oncogenic role in glioma, suggesting that 14-3-3β may have potential as a promising therapeutic target for glioma.

Genetic and immune features of resectable malignant brainstem gliomas.

We surveyed common genetic mutations (IDH1, H3F3A, PPM1D, and TP53) and immune features (PD-L1 expression and CD8+ T cell tumor infiltration) in a series of 62 malignant brainstem gliomas that were resected via microsurgery. IDH1 mutations were mutually exclusive with H3F3A mutations. IDH1 mutations appeared only in adults and occurred more frequently in tumors larger than 10cm3 (8/29 vs 1/32, Fisher’s exact test, p=0.010). H3F3A mutations occurred more frequently in children and adolescent patients (19/24 vs 18/38, chi-square test, p=0.013), low preoperative Karnofsky Performance Scale (KPS) patients (10/11 vs 20/43, chi-square test, p=0.021), and higher grade brainstem gliomas (8/21 in grade II vs 16/24 in grade III vs 13/17 in grade IV; chi-square test, p=0.038). PPM1D mutations clustered in H3F3A-mutated tumors (12/37), whereas were rare in H3F3A wildtype tumors (1/25). MGMT promoter methylations clustered in IDH1-mutated tumors (4/9), but were rare in H3F3A-mutated tumors (1/37). PD-L1 staining was detected in 59.7% of brainstem glioma specimens (37/62). High intra-tumoral CD8+ T cell density was less frequent in the H3F3A-mutated than H3F3A-wild-type tumors (4/37 vs. 11/25, p=0.005). Patients with H3F3A-mutated tumors (13.8 months overall survival) had much worse prognoses than those with IDH1-mutated (54.9 months, p=0.001) or H3F3A-IDH1 co-wildtype tumors (38.4 months, p=0.001). H3F3A mutations independently increased the relative risk of death as much as 4.19-fold according to a multivariate Cox regression model. Taken together, resectable malignant brainstem gliomas can be classified into three subtypes: H3F3A-mutated, IDH1 mutated and H3F3A-IDH1 co-wildtype tumors, which have distinct clinical characteristics, prognoses, genetic and immune features.

No news, bad news? A deeper examination of the correlation between patient functional status and level of postoperative telephone communication with the surgical team.

102 Background: In attempts to improve outcomes for and survival of geriatric oncology patients, studies have demonstrated the utility of phone communication as a tool for post-operative care. However, very little data is available to determine if this method of care is reaching the most vulnerable patients. The purpose of this study is to compare patient-surgical team phone communication for geriatric cancer patients of higher and lower preoperative functional status. Methods: This is a retrospective review of data from an internal geriatric assessment questionnaire and phone log data as recorded in the EHR at a single institution. Patients were stratified into two groups: those who had at least one recorded postoperative care phone call (PC) and those with no postoperative care phone call (NPC). Quantitative analysis of the data was performed, assessing the correlation between preoperative functional status and patient-surgical service communication in the first 30 postoperative days. Results: NPC group patients were more likely to be amongst the more frail patients, with lower preoperative functional status and a higher level of distress. Specifically, patients in the NPC group were more likely to be dependent for ADLs (61.0% vs. 50.8%, P = 0.013) and IADLs (59.6% VS. 44.7%, P = 0.001), and have a lower Karnofsky Performance Scale score (46.2% vs. 39.1%, P = 0.048) and also reported a higher level of distress (4.5 vs. 4.00, P = 0.001). There was a trend toward more cognitive impairment among the NPC group compared to the PC group (18.2% vs. 12.1%, P = 0.058). Conclusions: Our study highlights a disparity in the utilization of patient-surgical team phone calls as a method for postoperative care for more frail patients. Despite significant number of phone calls initiated during the postoperative period, mainly by surgical nurses, frail and distressed patients are more likely not to participate in a call. Future studies of postoperative phone communication with geriatric oncology patients should assess the utility of this tool for more frail patients and seek measures that will increase access and participation among this population.

Downregulation of LKB1 promotes tumor progression and predicts unfavorable prognosis in patients with glioma.

The liver kinase B1 (LKB1)/5′-adenosine monophosphate-activated protein kinase pathway has been reported to facilitate glioma cell growth by improving growth conditions. To investigate the clinical significance of LKB1 in human gliomas western blot analysis and quantitative polymerase chain reaction experiments were performed. The present study demonstrated that LKB1 expression was markedly decreased at the messenger RNA and protein levels in 30 freshly prepared glioma tissues, compared with non-neoplastic brain tissues (P<0.001). Subsequently, immunohistochemical analysis demonstrated that LKB1 immunostaining in 180 glioma tissues was significantly decreased compared with that in the corresponding non-neoplastic brain tissues (P<0.001). Notably, this downregulation frequently occurred in high-grade gliomas, and statistical analysis revealed that low LKB1 expression was significantly associated with large tumor size (P=0.02), advanced World Health Organization grade (P=0.006) and low Karnofsky performance scale (P=0.01). The prognostic value of LKB1 expression in patients with glioma was additionally evaluated using Kaplan-Meier survival curves and Cox proportional hazards regression models. As a result, the overall survival time of patients with glioma with low LKB1 expression was shorter compared with that of patients with high LKB1 expression (P<0.001), and low LKB1 expression also indicated decreased survival time in patients with high-grade glioma (P<0.001). Collectively, the present data indicated that the downregulation of LKB1 was closely associated with the malignant degree of human gliomas, exhibiting lower expression at a higher grade. Notably, LKB1 may serve as a potential prognostic biomarker for patients with glioma following surgery.