Prognostic Evaluation of Neurological Assessment of the Neuro-Oncology Scale in Glioblastoma Patients

Abstract

BackgroundThe aims of this study were to investigate the role of the Neurological Assessment of Neuro-Oncology (NANO) scale in predicting the prognosis of patients with glioblastoma, and compare these results to predicted data of the Karnofsky Performance Scale (KPS), and Eastern Cooperative Oncology Group (ECOG)/World Health Organization (WHO) performance status. Additionally, we examined other prognostic factors in glioblastoma patients.MethodsThe medical records of 76 patients with a new diagnosis of histologically ascertained glioblastoma in the period from January 2002 to December 2015 at the authors' institution were retrospectively reviewed. Clinical factors, including epidemiologic, radiologic, and therapeutic values were reviewed as well as the performance status assessed by the KPS, ECOG/WHO performance status, and NANO scale.ResultsThe mean overall survival was 19.8 months (95% confidence interval 15.2–25.4 months). At initial diagnosis, the mean value [±standard deviation (SD)] of KPS score, ECOG/WHO performance status, and NANO scale were 81 (±7.4), 1.3 (±0.6), and 7.3 (±3.8), respectively. Multivariate analysis for predicting survival showed odds ratios of KPS score, ECOG/WHO performance status, and NANO scale were 2.502 (≥80 vs. <80; p=0.024), 1.691 (0–1 vs. 2–5; p=0.047), and 2.763 (0–7 vs. 8–23; p=0.020), respectively. At the time of progression, the mean value (±SD) of KPS score, ECOG/WHO performance status, and NANO scale were 69 (±8.2), 1.6 (±0.7), and 11.4 (±4.2), respectively; multivariate analysis for predicting survival showed that the odd ratios for KPS score, ECOG/WHO performance status, and NANO scale were 2.007 (≥80 vs. <80; p=0.035), 1.321 (0–1 vs. 2–5; p=0.143), and 3.182 (0–7 vs. 8–23; p=0.002), respectively.ConclusionThe NANO scale provided a more detailed and objective measure of neurologic function than that currently used for predicting the prognosis of glioblastoma patients, especially at the time of progression.

Karnofsky Performance Scale and Neurological Assessment of Neuro-Oncology Scale as Early Predictor in Glioma

“…ROC Curve Analysis for (A) KPS and (B) NANO scale before surgery towards favorable outcome categorize NANO scale as low 0-6 and high 7-23) has the sensitivity of 81.1% and specificity of 60%. These findings differ from previous study (Lee et al, 2018). For high KPS they obtain a range of 80-100, whereas for NANO Scale low score is 0-7.…”

“…These performance scales were functioned as a scale parameter in assessing patients' performance pre-treatment, to analyse their overall survival. It was found that performance status estimated by the NANO scale was significantly associated with overall survival, and showed to be a more powerful method to predict the prognosis of glioblastoma than the KPS, during both initial diagnosis and disease progression (Lee et al, 2018). However, not many studies assessed the fluctuations in functional scale during the progression of the disease, nor used a functional scale improvement as a favourable outcome.…”

An Inflammatory Landscape for Preoperative Neurologic Deficits in Glioblastoma

“…A low preoperative performance and functional status is often perceived to confer poor prognosis in GBM (Chambless et al, 2015; Smedley et al, 2018). Its predictability of survival length, however, continues to be unreliable (Lee et al, 2018). We posit that the missing association between neurologic deficit and survival length, within our cohort and across the wider GBM population, is due to the need to incorporate a combination of multiple clinical attributes to accurately predict patient outcome.…”

“…GBM patients typically present a spectrum of generalized or focal neurologic symptoms including headaches, partial or generalized seizures, unilateral or bilateral paresis, hemiplegia, ataxia, visual defects, cognitive impairment, and personality changes (Iacob and Dinca, 2009; Burks et al, 2016; Georgakis et al, 2018). These symptoms persist throughout the course of the disease and worsen following surgical resection, severely limiting day-to-day functions, impacting patients’ quality of life, and even influencing survival outcomes (Martinez et al, 2008; Iacob and Dinca, 2009; Georgakis et al, 2018; Lee et al, 2018).…”

“…While preoperative neurologic symptoms are common amongst GBM patients, their form of manifestation is highly variable (Lee et al, 2018). Such variability is believed to arise from the direct and indirect interplay of tumor and patient factors (Kushner and Amidei, 2015).…”