Clinical StudySurvival analysis of 205 patients with glioblastoma multiforme: Clinical characteristics, treatment and prognosis in China
Introduction
Glioblastoma multiforme (GBM) is the most common and malignant primary brain tumour in adults and the median survival after diagnosis is about 1 year.[1], [2] The poor prognosis of GBM has been shown to be affected by multiple factors, both preoperative clinical characteristics (age, performance status, tumour location and socioeconomic status) and therapeutic characteristics (quality of surgery, radiotherapy and chemotherapy).[3], [4], [5], [6], [7], [8], [9], [10] The large population of China makes it an ideal setting for innovative therapeutic procedures. However, until now, almost all the analyses of GBM survival have been based on patients in Europe and the USA and few studies have focused on Chinese patients. We aimed to study the survival of patients with GBM in China and to identify independent preoperative variables and postoperative therapeutic modalities that were significant predictors of survival time, and to compare patient prognosis in China to the reported values in clinical trial control groups.
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Patient population
The study population consisted of 205 patients with primary GBM, who were treated from January 1999 to December 2004 at the Shandong University Qilu Hospital, LiaoCheng Brain Hospital and YanTai Yuhuangding Hospital.
Inclusion criteria for the study were as follows: (i) adults (⩾16 years old); (ii) tumour resection in which GBM had been confirmed histologically; (iii) a complete preoperative clinical record available; (iv) complete post-operative follow-up records available and (v) preoperative
Results
The clinical characteristics, univariate analysis, and the median survival time of factors affecting survival of all 205 patients are summarized in Table 1. Mean overall survival time was 16.7 months (95% CI 14.5–18.9 months) and median overall survival time was 12.0 months (95% CI 11.0–13.1 months). Survival rates after diagnosis were 82% at 6 months, 52% at 12 months, 27% at 18 months and 17% at 24 months. Following multivariate analysis, age, preoperative Karnofsky performance status (KPS), tumour
Preoperative clinical characteristics
Preoperative clinical characteristics such as age, preoperative KPS score and tumour location were important to predict the prognosis of patients with GBM. Younger age remains a strong prognostic factor for survival in multivariate analysis.[2], [6], [12], [13] In this study, the median survival of patients younger than 55 years old was 12.0 months (95% CI 10.6–13.4 months) versus (vs.) 9.0 months in older patients over 55 years (95% CI 5.9–12.1 months, p = 0.0004). The value of performance status
Conclusion
To date, this study is the largest and most comprehensive series in which the survival of Chinese patients with GBM has been explored. The median survival time post diagnosis for Chinese patients is 12 months, which is comparable to the 11.0–15.9 month range observed in Western patients. Three independent preoperative predictors of overall survival were age, preoperative KPS score, and tumour location on MRI/CT imaging. Radiotherapy was the most significant prognostic factor when considering
Acknowledgments
We gratefully acknowledge the support of the National Natural Science Foundation of China (30672163) and Health Elite 1020 project of Shandong province of China.
Thanks are due to Yunxiang Liu of Yantai Yuhuangding Hospital, Dr. Hongwei Qin and Stephanie Reynolds of The University of Alabama at Birmingham for the revision on this manuscript.
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