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J Neurol Surg A Cent Eur Neurosurg 2019; 80(04): 262-268
DOI: 10.1055/s-0039-1685170
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Association of Surgical Resection, Disability, and Survival in Patients with Glioblastoma

Yahya Ahmadipour
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Monika Kaur
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Daniela Pierscianek
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Oliver Gembruch
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Marvin Darkwah Oppong
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Oliver Mueller
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Ramazan Jabbarli
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Martin Glas
2   Division of Clinical Neurooncology, Department of Neurology, University Hospital Essen, Essen, Germany
,
Ulrich Sure
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
,
Nicolai El Hindy
1   Department of Neurosurgery, University Hospital Essen, Essen, Germany
› Author Affiliations
Further Information

Publication History

05 August 2018

11 January 2019

Publication Date:
09 April 2019 (online)

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Abstract

Objective Extent of resection (EOR) and Karnofsky Performance Status (KPS) are at odds in glioblastoma (GBM) surgery, that is, the anticipated postoperative disability limits the EOR. This study analyzes the correlation of different surgical modalities with the resulting physical status and survival of patients with GBM.

Methods A total of 565 patients with primary GBM were operated on in a single institution between 2006 and 2014. Possible surgical modalities comprised supratotal resection (SLR), gross total resection (GTR; ≥ 95% by volume), tumor debulking (TDB; ≤ 95% by volume), and stereotactic biopsy (SB). Pre- and postoperative KPS before and up to 4 weeks after surgery as well as overall survival (OS) rate were determined retrospectively. Hazard ratio (HR) and 95% confidence intervals were calculated using a Cox proportional hazards model.

Results Median postoperative KPS was ≥ 70, irrespective of surgical modality. Mean OS was 12.5 months. Multivariate analysis revealed age ≥ 70 years (HR: 1.93), preoperative KPS < 70 (HR: 2.15), and unmethylation in MGMT promoter (HR: 1.27) as independent factors for worse OS. Regarding surgical modality, SB was associated with the worst survival (HR: 2.3) followed by TDB (HR: 1.36). SLR was inferior to GTR (HR: 1.27).

Conclusion Higher EOR in patients with GBM does not seem inevitably correlated with increasing functional impairment, but better survival, provided there is a balanced preoperative indication. Nevertheless, SLR does not seem to be superior to GTR. Whenever possible, maximal safe resection should be considered in patients with GBM, even if an EOR ≥ 95% is not possible.

Keywords

glioblastoma - extent of resection - overall survival - KPS

Ethical Approval

The investigation was approved by the local ethic committees (protocol number 15–6505-BO).


 

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