Effect of pretreatment clinical factors on overall survival in glioblastoma multiforme: a Surveillance Epidemiology and End Results (SEER) population analysis

Abstract

BackgroundGlioblastoma Multiforme (GBM) is one of the most aggressive primary brain tumors and is associated with a dismal prognosis. The median survival after the primary diagnosis remains poor, even after multimodal treatment approaches. However, a few patients have been reported to have long term survival greater than three years. A number of studies have attempted to define factors capable of predicting long term outcomes in specific patient groups. This article reports the outcomes of a very large group of patients diagnosed with GBM, and analyzes specific prognostic factors known to influence survival in these patients.MethodsWe used the Surveillance, Epidemiology, and End Results (SEER) database of the US National Cancer Institute (NCI) to investigate various patient-related and treatment- related factors that could influence the long term survival in patients diagnosed with glioblastoma. A total of 34,664 patients aged 20 years or older with a diagnosis of GBM during the years 1973 to 2008 were studied. Overall survival outcomes were examined with Kaplan-Meier survival analysis and Cox hazard models.ResultsAsian/Pacific Islanders had a better survival compared to the white population (P = <0.001). Patients diagnosed with GBM during the years 2000 to 2008 had a superior survival rate when compared with earlier decades (P = <0 .001). Statistically significant improvements in overall survival were also found for patients who received surgical resections, and adjuvant radiation treatment versus no radiation (P-values <0.001). Young age was also found to be highly predictive of improved overall survival rates when separated into age groups as well as when studied as a continuous variable.ConclusionsClinical pretreatment and treatment factors, including young age at diagnosis, Asian/Pacific Islander ethnicity, recent year of diagnosis, surgical resection and the use of adjuvant radiation therapy favorably influence survival in patients diagnosed with glioblastoma.Trial RegistrationAll data were obtained from the United States Surveillance Epidemiology and End Results (SEER) database.

Glioblastoma multiforme outcomes of 107 patients treated in two Singapore institutions

“…Nonetheless, such geoethnic variations are well described, such as in a number of population-based studies showing that the incidence of GBM is higher among Caucasians than other ethnic groups. (7,(10)(11)(12) However, there has been no conclusive evidence that the clinical outcomes of GBM differ among ethnic groups. (13) Population-based studies conducted in Korea and China showed that the survival of Asian patients was similar to that of Western populations.…”

“…(1,11,20) These factors include age, performance status, histology, extent of surgical resection, and the addition of radiotherapy and chemotherapy as adjuvants. Some authors have attempted to stratify patients into prognostic groups based on these factors in order to predict survival.…”

“…(19) The present study has shown that the prognostic factors in our local population are similar to those reported worldwide. (11,13,18,21) Increased understanding of the molecular mechanisms of GBM has led to the development of predictive models that incorporate the use of molecular markers, which in turn has impacted the clinical outcomes of patients with GBM. One significant example is the development of an online GBM calculator by the European Organisation for Research and Treatment of Cancer.…”

Case Series: Gamma Knife as Salvage Therapy for Recurrent Glioblastoma Multiforme

“…Evidence shows that patient age is a reliable predictor of overall survival following the initial diagnosis of GBM [10,11,19,30,39], but this study and others appear to suggest that it is not associated with survival differences following GKRS salvage (Tables 3 and 4) [15,18]. These data, along with the aforementioned RTOG-RPA comparison, suggest that older patients with favorable KPS scores are likely to appreciate similar post-salvage survival advantages as younger patients.…”

“…Factors which historically predict a more favorable prognosis for GBM patients are age less than 50, Karnofsky Performance Status (KPS) of 90 or better, and achieving gross total resection [10][11][12][13][14]. Additional studies have shown an improved prognosis for smaller volume tumors (<15cc), unifocal lesions, use of additional salvage therapies, and O6-methylguanine-DNA methyltransferase (MGMT) promoter methylation, and Asian/Pacific Islander ethnicity [15][16][17][18][19].…”