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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(02): 080-090
DOI: 10.1055/s-0037-1603199
Original Article | Artigo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

Glioblastoma Multiforme: uma análise avançada de 153 pacientes e revisão da literatura
Mohammad Sadegh Nikdad
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Farshid Farhan
3   Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Milad Shafizadeh
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Atefeh Sadat Mirmohseni
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Mohsen Afarideh
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Shabnam Asadi Komeleh
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Marzieh Lashkari
3   Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Morsaleh Ganji
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Alireza Ghajar
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Saeed Shafiei
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
,
Yalda Shafizadeh
4   Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
,
Ali Kazemian
3   Department of Radiation Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
,
Hooshang Saberi
1   Neurosurgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2   Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
› Author Affiliations
Further Information

Publication History

30 December 2016

16 March 2017

Publication Date:
22 May 2017 (online)

Also available at
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Abstract

Objective Glioblastoma multiforme (GBM) is an aggressive primary tumor with frequent recurrences that leaves patients with a short survival time and a low quality of life. The aim of this study was to review the prognostic factors in patients with glioblastoma multiforme.

Material and Methods The focus of this retrospective study was a group of 153 patients with supratentorial GBM tumors, who were admitted to a tertiary-care referral academic center from 2005 to 2013. The factors associated with survival and local recurrence were assessed using the hazard ratio (HR) function of Cox proportional hazards regression and neural network analysis.

Results Out of the 153 patients, 99 (64.7%) were male. The average age of the patients was 55.69 ± 15.10 years. The median overall survival (OS) and progression-free survival (PFS) rates were 14.0 and 7.10 months respectively. In the multivariate analysis, age (HR = 2.939, p < 0.001), operative method (HR = 7.416, p < 0.001), temozolomide (TMZ, HR = 11.723, p < 0.001), lomustine (CCNU, HR = 8.139, p < 0.001), occipital lobe involvement (HR = 3.088, p < 0.001) and Karnofsky Performance Status (KPS, HR = 4.831, p < 0.001) scores were shown to be significantly associated with a higher OS rate. Furthermore, higher KPS (HR = 7.292, p < 0.001) readings, the operative method (HR = 0.493, p = 0.005), the use of CCNU (HR = 2.047, p = 0.003) and resection versus chemotherapy (HR = 0.171, p < 0.001) were the significant factors associated with the local recurrence of the tumor.

Conclusion Our findings suggest that the use of CCNU and TMZ, the operative method and higher KPS readings are associated with both higher survival and lower local recurrence rates.

Resumo

Objetivo Glioblastoma multiforme (GBM) é um tumor primário agressivo com recorrências frequentes que deixam pacientes com uma curta sobrevida e baixa qualidade de vida. O objetivo deste estudo é rever fatores de prognóstico em pacientes com glioblastoma multiforme.

Material e Métodos O foco deste estudo retrospectivo foi um grupo de 153 pacientes com tumores GBM supratentoriais, os quais deram entrada em um centro acadêmico de atendimento de referência de 2005 a 2013. Fatores associados com a sobrevivência e a recorrência local foram avaliados usando a razão de risco (RR) da regressão de risco proporcional de Cox e análise de redes neurais.

Resultados Dos 153 pacientes, 99 (64,7%) eram homens. A média de idade foi de 55,69 ± 15,10 anos. A sobrevida geral (SG) mediana e a sobrevida de livre progressão (SLP) foram 14,0 e 7,10 meses, respectivamente. Na análise multivariada, idade (RR = 2,939, p < 0,001), método operatório (RR = 7,416, p < 0,001), temozolomida (TMZ, RR = 11,723, p < 0,001), lomustina (CCNU, RR = 8,139, p < 0,001), envolvimento do lobo occipital (RR = 3,088, p < 0,001) e Índice de Desempenho de Karnofsky (IDK, RR = 4,831, p < 0,001) foram identificados como significativamente associados a uma SG maior. Além disso, leituras maiores de IDK (RR = 7,292, p < 0,001), o método operatório (RR = 0,493, p = 0,005), o uso de CCNU (RR = 2,047, p = 0,003) e ressecção versus quimioterapia (RR = 0,171, p < 0,001) foram fatores significativos associados à recorrência local de tumor.

Conclusão Nossos resultados sugerem que o uso de CCNU e TMZ, o método operatório e leituras maiores de IDK estão associados tanto à maior sobrevida quanto à menor recorrência local.

Keywords

glioblastoma multiforme - survival - local recurrence

Palavras-chave

glioblastoma multiforme - sobrevida - recorrência local
 

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