The prognostic value of peri-operative neurological performance in glioblastoma patients
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IDH-wild-type glioblastoma (GBM) is a disease with devastating prognosis. First-line therapy consists of gross total resection and adjuvant radiotherapy with concomitant temozolomide. Several clinical parameters have been identified to provide prognostic value. We investigated whether peri-operative overall neurological performance could also be used to evaluate patients’ prognosis.
All patients with histologically diagnosed GBM between 2014 and 2017 over 18 years and MRI within 72 h after surgery were reviewed. To quantify neurological performance, the medical research council neurological performance score (MRC-NPS) was used. Univariate analysis with Kaplan–Meier estimate and log-rank test was performed. Survival prediction and multivariate analysis were performed employing Cox proportional hazard regression.
One hundred thirty-nine patients were included. In univariate analysis, survival decreased with increasing post-operative MRC-NPS scale. Moreover, post-operative MRC-NPS of 4 was statistically significant associated with reduced overall survival when analyzed for complete (p = 0.027) and partial resection (p = 0.002) as well as unilobar (p = 0.003) and multilobar tumor location (p < 0.0005). In multivariate analysis, extent of resection (hazard ratio (HR) 3.142), adjuvant therapy regimen (HR 3.001), tumor location (HR 2.005), and post-operative MRC-NPS (HR 2.310) had significant influence on overall survival.
We propose the post-operative neurological performance as an independent prognostic factor for GBM patients.
KeywordsGlioblastoma Prognostic factors Neurologic performance
95% confidence interval
European Association of Neuro-Oncology
extent of resection
health-related quality of life
Karnofsky performance scale
O6-methylguanine DNA methyltransferase
medical research council neurological performance score
magnetic resonance imaging
We acknowledge support from the German Research Foundation (DFG) and Leipzig University within the program of Open Access Publishing.
Study design and data analysis: JD, JM, KJ, TW, FW; histopathological analysis: CE; date of death analysis: ST, JD; manuscript: JD, TW, FW, CE, JM, JM.
Compliance with ethical standards
Data collection and analysis were approved by the ethical committee of Medical Faculty, University of Leipzig (No. 102/19-ek), and carried out in accordance with data protection guidelines.
Conflict of interest
The authors declare that they have no conflict of interest.
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