A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival

Michel Lacroix Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Michel Lacroix in
Current site
Google Scholar
PubMed Close
 M.D.
,
Dima Abi-Said Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Dima Abi-Said in
Current site
Google Scholar
PubMed Close
 Ph.D.
,
Daryl R. Fourney Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Daryl R. Fourney in
Current site
Google Scholar
PubMed Close
 M.D.
,
Ziya L. Gokaslan Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Ziya L. Gokaslan in
Current site
Google Scholar
PubMed Close
 M.D.
,
Weiming Shi Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Weiming Shi in
Current site
Google Scholar
PubMed Close
 M.D.
,
Franco DeMonte Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Franco DeMonte in
Current site
Google Scholar
PubMed Close
 M.D.
,
Frederick F. Lang Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Frederick F. Lang in
Current site
Google Scholar
PubMed Close
 M.D.
,
Ian E. McCutcheon Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Ian E. McCutcheon in
Current site
Google Scholar
PubMed Close
 M.D.
,
Samuel J. Hassenbusch Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Samuel J. Hassenbusch in
Current site
Google Scholar
PubMed Close
 M.D., Ph.D.
,
Eric Holland Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Eric Holland in
Current site
Google Scholar
PubMed Close
 M.D., Ph.D.
,
Kenneth Hess Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Kenneth Hess in
Current site
Google Scholar
PubMed Close
 Ph.D.
,
Christopher Michael Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Christopher Michael in
Current site
Google Scholar
PubMed Close
 M.D.
,
Daniel Miller Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Daniel Miller in
Current site
Google Scholar
PubMed Close
 M.D.
, and
Raymond Sawaya Department of Neurosurgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas

Search for other papers by Raymond Sawaya in
Current site
Google Scholar
PubMed Close
 M.D.
Page Range:
190–198
Volume/Issue:
Volume 95: Issue 2
DOI link:
https://doi.org/10.3171/jns.2001.95.2.0190
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
Click here for subscription options

  • Purchase Now

    USD  $45.00

  • JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

    USD  $525.00

  • JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

    USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object. The extent of tumor resection that should be undertaken in patients with glioblastoma multiforme (GBM) remains controversial. The purpose of this study was to identify significant independent predictors of survival in these patients and to determine whether the extent of resection was associated with increased survival time.

Methods. The authors retrospectively analyzed 416 consecutive patients with histologically proven GBM who underwent tumor resection at the authors' institution between June 1993 and June 1999. Volumetric data and other tumor characteristics identified on magnetic resonance (MR) imaging were collected prospectively.

Conclusions. Five independent predictors of survival were identified: age, Karnofsky Performance Scale (KPS) score, extent of resection, and the degree of necrosis and enhancement on preoperative MR imaging studies. A significant survival advantage was associated with resection of 98% or more of the tumor volume (median survival 13 months, 95% confidence interval [CI] 11.4–14.6 months), compared with 8.8 months (95% CI 7.4–10.2 months; p < 0.0001) for resections of less than 98%. Using an outcome scale ranging from 0 to 5 based on age, KPS score, and tumor necrosis on MR imaging, we observed significantly longer survival in patients with lower scores (1–3) who underwent aggressive resections, and a trend toward slightly longer survival was found in patients with higher scores (4–5). Gross-total tumor resection is associated with longer survival in patients with GBM, especially when other predictive variables are favorable.

  • Collapse
  • Expand

Contributor Notes

Address reprint requests to: Raymond Sawaya, M.D., Department of Neurosurgery, Box 442, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030.
  • 1.

    Albert FK, , Forsting M, & Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45–61, 1994 Albert FK, Forsting M, Sartor K, et al: Early postoperative magnetic resonance imaging after resection of malignant glioma: objective evaluation of residual tumor and its influence on regrowth and prognosis. Neurosurgery 34:45–61, 1994

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    Ammirati M, , Galicich JH, & Arbit E, et al: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 21:607–614, 1987 Ammirati M, Galicich JH, Arbit E, et al: Reoperation in the treatment of recurrent intracranial malignant gliomas. Neurosurgery 21:607–614, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Ammirati M, , Vick N, & Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206, 1987 Ammirati M, Vick N, Liao Y, et al: Effect of the extent of surgical resection on survival and quality of life in patients with supratentorial glioblastomas and anaplastic astrocytomas. Neurosurgery 21:201–206, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Andreou J, , George AE, & Wise A, et al: CT prognostic criteria of survival after malignant glioma surgery. AJNR 4:488–490, 1983 Andreou J, George AE, Wise A, et al: CT prognostic criteria of survival after malignant glioma surgery. AJNR 4:488–490, 1983

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Avellanosa AM, , West CR, & Tsukada Y, et al: Chemotherapy of nonirradiated malignant gliomas. Phase II: study of the combination of methyl-CCNU, vincristine, and procarbazine. Cancer 44:839–846, 1979 Avellanosa AM, West CR, Tsukada Y, et al: Chemotherapy of nonirradiated malignant gliomas. Phase II: study of the combination of methyl-CCNU, vincristine, and procarbazine. Cancer 44:839–846, 1979

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Burger PC, & Green SB: Patient age, histological features, and length of survival in patients with glioblastoma multiforme. Cancer 59:1617–1625, 1987 Burger PC, Green SB: Patient age, histological features, and length of survival in patients with glioblastoma multiforme. Cancer 59:1617–1625, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220, 1972 Cox DR: Regression models and life tables. J R Stat Soc B 34:187–220, 1972

  • 8.

    Curran WJ Jr, , Scott CB, & Horton J, et al: Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials. J Neurooncol 12:219–227, 1992 Curran WJ Jr, Scott CB, Horton J, et al: Does extent of surgery influence outcome for astrocytoma with atypical or anaplastic foci (AAF)? A report from three Radiation Therapy Oncology Group (RTOG) trials. J Neurooncol 12:219–227, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Daumas-Duport C, , Scheithauer B, & O'Fallon J, et al: Grading of astrocytomas. A simple and reproducible method. Cancer 62:2152–2165, 1988 Daumas-Duport C, Scheithauer B, O'Fallon J, et al: Grading of astrocytomas. A simple and reproducible method. Cancer 62:2152–2165, 1988

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Earnest F IV, , Kelly PJ, & Scheithauer BW, et al: Cerebral astrocytomas: histopathological correlation of MR and CT contrast enhancement with stereotactic biopsy. Radiology 166:823–827, 1988 Earnest F IV, Kelly PJ, Scheithauer BW, et al: Cerebral astrocytomas: histopathological correlation of MR and CT contrast enhancement with stereotactic biopsy. Radiology 166:823–827, 1988

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Fadul C, , Wood J, & Thaler H, et al: Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 38:1374–1379, 1988 Fadul C, Wood J, Thaler H, et al: Morbidity and mortality of craniotomy for excision of supratentorial gliomas. Neurology 38:1374–1379, 1988

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Gehan EA, & Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:189–195, 1977 Gehan EA, Walker MD: Prognostic factors for patients with brain tumors. Natl Cancer Inst Monogr 46:189–195, 1977

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Gilbert H, , Kagan AR, & Cassidy F, et al: Glioblastoma multiforme is not a uniform disease. Cancer Clin Trials 4:87–89, 1981 Gilbert H, Kagan AR, Cassidy F, et al: Glioblastoma multiforme is not a uniform disease. Cancer Clin Trials 4:87–89, 1981

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Hammoud MA, , Sawaya R, & Shi W, et al: Prognostic significance of preoperative MRI scans in glioblastoma multiforme. J Neurooncol 27:65–73, 1996 Hammoud MA, Sawaya R, Shi W, et al: Prognostic significance of preoperative MRI scans in glioblastoma multiforme. J Neurooncol 27:65–73, 1996

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Harsh GR IV, , Levin VA, & Gutin PH, et al: Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21:615–621, 1987 Harsh GR IV, Levin VA, Gutin PH, et al: Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery 21:615–621, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Hess KR: Extent of resection as a prognostic variable in the treatment of gliomas. J Neurooncol 42:227–231, 1999 Hess KR: Extent of resection as a prognostic variable in the treatment of gliomas. J Neurooncol 42:227–231, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Kaplan EL, & Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958 Kaplan EL, Meier P: Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481, 1958

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Kelly PJ: Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 25:185–195, 1989 Kelly PJ: Stereotactic biopsy and resection of thalamic astrocytomas. Neurosurgery 25:185–195, 1989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Kelly PJ, , Daumas-Duport C, & Kispert DB, et al: Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66:865–874, 1987 Kelly PJ, Daumas-Duport C, Kispert DB, et al: Imaging-based stereotaxic serial biopsies in untreated intracranial glial neoplasms. J Neurosurg 66:865–874, 1987

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20.

    Kiwit JC, , Floeth FW, & Bock WJ: Survival in malignant glioma: analysis of prognostic factors with special regard to cytoreductive surgery. Zentralbl Neurochir 57:76–88, 1996 Kiwit JC, Floeth FW, Bock WJ: Survival in malignant glioma: analysis of prognostic factors with special regard to cytoreductive surgery. Zentralbl Neurochir 57:76–88, 1996

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Kleihues P, , Burger PC, & Scheithauer BW, et al: Histological Typing of Tumours of the Central Nervous System, ed 2. New York: Springer-Verlag, 1993 Kleihues P, Burger PC, Scheithauer BW, et al: Histological Typing of Tumours of the Central Nervous System, ed 2. New York: Springer-Verlag, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Kreth FW, , Warnke PC, & Scheremet R, et al: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78:762–766, 1993 Kreth FW, Warnke PC, Scheremet R, et al: Surgical resection and radiation therapy versus biopsy and radiation therapy in the treatment of glioblastoma multiforme. J Neurosurg 78:762–766, 1993

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Lai DM, , Lin SM, & Tu YK, et al: Therapy for supratentorial malignant astrocytomas: survival and possible prognostic factors. J Formos Med Assoc 92:220–226, 1993 Lai DM, Lin SM, Tu YK, et al: Therapy for supratentorial malignant astrocytomas: survival and possible prognostic factors. J Formos Med Assoc 92:220–226, 1993

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Nazzaro JM, & Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytoma in adults. J Neurosurg 73:331–344, 1990 Nazzaro JM, Neuwelt EA: The role of surgery in the management of supratentorial intermediate and high-grade astrocytoma in adults. J Neurosurg 73:331–344, 1990

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Newell J, , Ransohoff J, & Kaplan B: Glioblastoma in the older patient: how long a course of radiotherapy is necessary? J Neurooncol 6:325–327, 1988 Newell J, Ransohoff J, Kaplan B: Glioblastoma in the older patient: how long a course of radiotherapy is necessary? J Neurooncol 6:325–327, 1988

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Nitta T, & Sato K: Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer 75:2727–2731, 1995 Nitta T, Sato K: Prognostic implications of the extent of surgical resection in patients with intracranial malignant gliomas. Cancer 75:2727–2731, 1995

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Prados MD, , Gutin PH, & Phillips TL, et al: Highly anaplastic astrocytoma: a review of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys 23:3–8, 1992 Prados MD, Gutin PH, Phillips TL, et al: Highly anaplastic astrocytoma: a review of 357 patients treated between 1977 and 1989. Int J Radiat Oncol Biol Phys 23:3–8, 1992

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Quigley MR, & Maroon JC: The relationship between survival and the extent of resection in patients with supratentorial malignant gliomas. Neurosurgery 29:385–389, 1991 Quigley MR, Maroon JC: The relationship between survival and the extent of resection in patients with supratentorial malignant gliomas. Neurosurgery 29:385–389, 1991

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Ringertz N: “Grading” of gliomas. Acta Pathol Microbiol Scand 27:51–64, 1950 Ringertz N: “Grading” of gliomas. Acta Pathol Microbiol Scand 27:51–64, 1950

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Salcman M: Resection and reoperation in neuro-oncology. Rationale and approach. Neurol Clin 3:831–842, 1985 Salcman M: Resection and reoperation in neuro-oncology. Rationale and approach. Neurol Clin 3:831–842, 1985

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 31.

    Salcman M: Surgical decision-making for malignant brain tumors. Clin Neurosurg 35:285–313, 1989 Salcman M: Surgical decision-making for malignant brain tumors. Clin Neurosurg 35:285–313, 1989

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Sawaya R: Extent of resection in malignant gliomas: a critical summary. J Neurooncol 42:303–305, 1999 Sawaya R: Extent of resection in malignant gliomas: a critical summary. J Neurooncol 42:303–305, 1999

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Sawaya R, , Hammoud M, & Schoppa D, et al: Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1056, 1998 Sawaya R, Hammoud M, Schoppa D, et al: Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42:1044–1056, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Scott GM, & Gibberd FB: Epilepsy and other factors in the prognosis of gliomas. Acta Neurol Scand 61:227–239, 1980 Scott GM, Gibberd FB: Epilepsy and other factors in the prognosis of gliomas. Acta Neurol Scand 61:227–239, 1980

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35.

    Segall HD, , Destian S, & Nelson MD Jr, et al: CT and MR imaging in malignant gliomas, in Apuzzo MLJ (ed): Malignant Cerebral Glioma. Park Ridge, IL: American Association of Neurological Surgeons, 1990, pp 63–77 Segall HD, Destian S, Nelson MD Jr, et al: CT and MR imaging in malignant gliomas, in Apuzzo MLJ (ed): Malignant Cerebral Glioma. Park Ridge, IL: American Association of Neurological Surgeons, 1990, pp 63–77

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Shapiro WR, , Green SB, & Burger PC, et al: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant gliomas. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71:1–9, 1989 Shapiro WR, Green SB, Burger PC, et al: Randomized trial of three chemotherapy regimens and two radiotherapy regimens in postoperative treatment of malignant gliomas. Brain Tumor Cooperative Group Trial 8001. J Neurosurg 71:1–9, 1989

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37.

    Shi WM, , Wildrick DM, & Sawaya R: Volumetric measurement of brain tumors from MR imaging. J Neurooncol 37:87–93, 1998 Shi WM, Wildrick DM, Sawaya R: Volumetric measurement of brain tumors from MR imaging. J Neurooncol 37:87–93, 1998

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Walker MD, , Green SB, & Byar DP, et al: Randomized comparisons of radiotherapy and nitrosoureas for treatment of malignant glioma after surgery. N Engl J Med 303:1323–1329, 1980 Walker MD, Green SB, Byar DP, et al: Randomized comparisons of radiotherapy and nitrosoureas for treatment of malignant glioma after surgery. N Engl J Med 303:1323–1329, 1980

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Wood JR, , Green SB, & Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338–343, 1988 Wood JR, Green SB, Shapiro WR: The prognostic importance of tumor size in malignant gliomas: a computed tomographic scan study by the Brain Tumor Cooperative Group. J Clin Oncol 6:338–343, 1988

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 22078 4451 337
Full Text Views 4059 511 86
PDF Downloads 2744 437 37
EPUB Downloads 0 0 0