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

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.

Abbreviations: CNS, central nervous system, CTR, controlled trial, ETR, extent of tumor resection, GBM, glioblastoma multiforme, GCS, Glasgow Coma Scale, ICU, intensive care unit, KPS, Karnofsky performance score, MRI, magnetic resonance imaging, RT, radiotherapy, TUMS, Tehran University of Medical Sciences, WHO, World Health Organization

Keywords: Controlled trials, Developing country, Glioblastoma multiformis, Prognosis, Resection, Survival