The effects of new or worsened postoperative neurological deficits on survival of patients with glioblastoma

Abstract

OBJECTIVE An increased extent of resection (EOR) has been shown to improve overall survival of patients with glioblastoma (GBM) but has the potential for causing a new postoperative neurological deficit. To investigate the impact of surgical neurological morbidity on survival, the authors performed a retrospective analysis of the clinical data from patients with GBM to quantify the impact of a new neurological deficit on the survival benefit achieved with an increased EOR. METHODS The data from all GBM patients who underwent resection at the University of Florida from 2010 to 2015 with postoperative imaging within 72 hours of surgery were included in the study. Retrospective analysis was performed on clinical outcomes and tumor volumes determined on postoperative and follow-up imaging examinations. RESULTS Overall, 115 patients met the inclusion criteria for the study. Tumor volume at the time of presentation was a median of 59 cm (enhanced on T1-weighted MRI scans). The mean EOR (± SD) was 94.2% ± 8.7% (range 59.9%-100%). Almost 30% of patients had a new postoperative neurological deficit, including motor weakness, sensory deficits, language difficulty, visual deficits, confusion, and ataxia. The neurological deficits had resolved in 41% of these patients on subsequent follow-up examinations. The median overall survival was 13.1 months (95% CI 10.9-15.2 months). Using a multipredictor Cox model, the authors observed that increased EOR was associated with improved survival except for patients with smaller tumor volumes (≤ 15 cm). A residual volume of 2.5 cm or less predicted a favorable overall survival. Developing a postoperative neurological deficit significantly affected survival (9.2 months compared with 14.7 months, p = 0.02), even if the neurological deficit had resolved by the first follow-up. However, there was a trend of improved survival among patients with resolution of a neurological deficit by the first follow-up compared with patients with a permanent neurological deficit. Any survival benefit from achieving a 95% EOR was abrogated by the development of a new neurological deficit postoperatively. CONCLUSIONS Developing a new neurological deficit after resection of GBM is associated with a decrease in overall survival. A careful balance between EOR and neurological compromise needs to be taken into account to reduce the likelihood of neurological morbidity from surgery.

Transcortical insular glioma resection: clinical outcome and predictors

“…Insular surgeries resulting in motor morbidity have been associated with a poorer prognosis. 16,21 Similarly, we have shown the morbidity associated with development of neurological deficits.…”

A Novel Comprehensive Clinical Stratification Model to Refine Prognosis of Glioblastoma Patients Undergoing Surgical Resection

“…The variety in overall survival and response to treatment in GBM is largely due to the high heterogeneity of GBM with a different distribution of aggressive biological traits across tumors, as well as within a single tumor [12][13][14]. To classify GBM cases according to this heterogeneity, different prognostic factors have been suggested for GBM, including age, performance status, specific molecular markers [e.g., MGMT methylation (O 6 -methylguanine-DNA methyl-transferase), mutation of IDH1, IDH2(isocitrate dehydrogenase) or TERT (telomerase reverse transcriptase), 1p19q codeletion, overexpression of EGFR (epidermal growth factor receptor)], the size of necrosis and the extent of resection (EOR) [15][16][17][18][19][20][21][22]. The role of EOR in improving survival in patients with GBM has widely been demonstrated, with more extensive resections providing added advantages [8,9,16,18,19,[23][24][25][26][27][28][29][30][31][32][33].…”

Overall survival time prediction for high-grade glioma patients based on large-scale brain functional networks

“…We included neither post-operative imaging nor post-operative clinical features because our study here was aimed to investigate the feasibility of preoperative prediction. Nevertheless, we by no means think that surgical and post-surgical treatments are irrelevant to OS(Rahman et al 2017). A total of 709 features (6 metrics × 116 regions + 13 traditional features) were extracted for each network per subject.…”