Evaluating the prognostic factors effective on the outcome of patients with glioblastoma multiformis: does maximal resection of the tumor lengthen the median survival?

• Published in: World neurosurgery 2010-02, Vol.73 (2), p.128-134
• Main Authors: Allahdini, Faramarz-, MD, Amirjamshidi, Abbass, MD, MPH, Reza-Zarei, Mohammad, MD, MPH, Abdollahi, Morteza, MD, PhD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Biological and medical sciences; Brain Neoplasms - mortality; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Cohort Studies; Controlled trials; Developing country; Female; Glioblastoma - mortality; Glioblastoma - pathology; Glioblastoma - surgery; Glioblastoma multiformis; Humans; Male; Medical sciences; Middle Aged; Neurosurgery; Prognosis; Proportional Hazards Models; Resection; Retrospective Studies; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival; Survival Rate; Treatment Outcome; Tumor Burden; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2009.06.001

Abstract Background The ETR that should be undertaken in patients with GBM remains controversial. This study aims to reiterate some independent predicting factors and to underscore the role and the ETR in increasing the survival of patients in the situation of developing countries, that is, without preoperative MRI or tractography. The authors submit additional information to be added to the list of CTRs in the management of malignant brain tumors. Methods The authors prospectively analyzed a cohort of 35 consecutive patients with histologically proven GBM who underwent tumor resection in surgically amenable areas for the first time at Sina Hospital, Tehran, between 2003 and 2005. Demographic data, volumetric measurements, and other characteristics identified on preoperative and immediate postoperative MR imaging as well as intraoperative and postoperative clinical data were collectively analyzed by SPSS for Windows, version 11.5 (SPSS, Chicago, Ill). Results Cox proportional hazards model multivariate analysis identified the following independent predictors of survival: Karnofsky performance scale ≥80 ( P = .01), ETR ( P = .01), tumor location in functionally silent prefrontal area ( P = .002) vs tumor location in corpus callosum ( P = .001), postoperative RT ( P = .004), and postoperative chemotherapy ( P = .001) Conclusion Maximal resection of the tumor volume is an independent variable associated with longer survival times in patient with GBM. Gross total resection should be performed whenever possible, although not at the expense of increased morbidity.