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Prognostic factors for survival of patients with glioblastoma: Recursive
partitioning analysis
Kathleen R. Lamborn, Susan M. Chang, Michael D. Prados
Department of Neurological Surgery,
University of California San Francisco, San Francisco, CA 94143-0112, USA
Survival for patients with glioblastoma multiforme is short, and current
treatments provide limited benefit.
Therefore, there is interest in conducting
phase 2 trials of experimental treatments in newly diagnosed patients.
However,
this requires historical data with which to compare the experimental therapies.
Knowledge of prognostic markers would also allow stratification into risk groups
for phase 3 randomized trials.
In this retrospective study of 832 glioblastoma
multiforme patients enrolled into prospective clinical trials at the time of
initial diagnosis, we evaluated several potential prognostic markers for
survival to establish risk groups.
Analyses were done using both Cox
proportional hazards modeling and recursive partitioning analyses.
Initially,
patients from 8 clinical trials, 6 of which included adjuvant chemotherapy, were
included.
Subsequent analyses excluded trials with interstitial brachytherapy,
and finally included only nonbrachytherapy trials with planned adjuvant
chemotherapy.
The initial analysis defined 4 risk groups.
The 2 lower risk
groups included patients under the age of 40, the lowest risk group being young
patients with tumor in the frontal lobe only.
An intermediate-risk group
included patients with Karnofsky performance status (KPS) 70, subtotal or total
resection, and age between 40 and 65.
The highest risk group included all
patients over 65 and patients between 40 and 65 with either KPS 80 or biopsy
only.
Subgroup analyses indicated that inclusion of adjuvant chemotherapy
provides an increase in survival, although that improvement tends to be minimal
for patients over age 65, for patients over age 40 with KPS less than 80, and
for those treated with brachytherapy.
© 2004 Duke University Press
Source: http://fiordiliji.ingentaselect.com/vl=7032561/cl=28/nw=1/rpsv/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v6n3/s6/p227
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