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Indicators of Functional Status for Primary Malignant Brain Tumour Patients

Published online by Cambridge University Press:  02 December 2014

Miguel Bussière ,
Wilma Hopman ,
Andrew Day ,
Alicia Paris Pombo ,
Teresa Neves  and
Francisco Espinosa
Miguel Bussière
Affiliation:
Department of Clinical Neurological Sciences, London Health Sciences Centre, University of Western Ontario, ON, Canada
Wilma Hopman
Affiliation:
Clinical Research Centre, Queen’s University, Kingston, ON, Canada Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Andrew Day
Affiliation:
Clinical Research Centre, Queen’s University, Kingston, ON, Canada
Alicia Paris Pombo
Affiliation:
Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Teresa Neves
Affiliation:
Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada
Francisco Espinosa
Affiliation:
Division of Neurosurgery, Department of Surgery, Queen’s University, Kingston, ON, Canada
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Abstract

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Background:

We compared the functional status and survival time of patients with malignant gliomas.

Methods:

This retrospective review included 143 patients diagnosed with malignant gliomas. Patients were grouped according to histopathological diagnosis. To measure functional status, patients were assigned a Karnofksy performance status (KPS) score at the time of presentation and at one, three, six, nine, 12 months and yearly intervals thereafter. Data were analyzed using descriptive methods as well as Kruskal-Wallis tests, Chi-square tests, Log-Rank tests and Cox’s proportional hazards modeling.

Results:

Eighty-four patients were male. The median age of patients was 63 years. One hundred and seven patients had a histopathological diagnosis of glioblastoma multiforme, 23 of anaplastic astrocytoma and 13 of anaplastic oligodendroglioma. Twenty-nine patients received aggressive multimodal treatment, 83 received intermediate treatment and the remaining 31 patients received conservative therapy. Significant treatment complications occurred in 33% of patients including four post-operative deaths. The anaplastic oligodendroglioma group had lower mortality and maintained better KPS scores over time, as did patients receiving full treatment. The most significant prognostic factors for functional status included age, pretreatment KPS, and type of treatment received. The most significant factors associated with time until death included age, severity of comorbidities, pretreatment KPS, presence of confusion, histopathological diagnosis and type of treatment received.

Conclusion:

In patients with malignant gliomas, younger age, better functional status at presentation and aggressive multimodal treatment were associated with improved longer-term functional status and survival. Confirmation of the effect of multimodal treatment on patient functional status would require a randomised controlled clinical trial.

Résumé:

RÉSUMÉ:Introduction:

Nous avons compare l’état fonctionnel et la survie de patients atteints de gliomes malins

Méthodes:

Cette revue rétrospective porte sur 143 patients porteurs d’un gliome malin. Ils ont été classés selon le diagnostic anatomopathologique. Un score était attribué à chaque patient selon l’indice fonctionnel de Karnofksy (IFK) à la consultation initiale et après 1, 3, 6, 9 et 12 mois de suivi et de façon annuelle par la suite. Les données ont été analysées au moyen de méthodes descriptives ainsi que du test de Kruskal–Wallis, du test du chi–carré, du test du log–rank et du modèle à hasard proportionnel de Cox.

Résultats:

Quatrevingt– quatre patients étaient des hommes et l’âge médian des patients était de 63 ans. Selon l’examen anatomopathologique, cent sept patients avaient un glioblastome multiforme, alors que chez 23 la tumeur était un astrocytome anaplasique et chez 13 un oligodendrogliome anaplasique. Vingt–neuf patients ont reçu une polythérapie agressive, 83 ont reçu un traitement intermédiaire et les 31 autres patients ont reçu un traitement conservateur. 33% des patients ont eu des complications importantes dues au traitement, dont quatre décès en période post–opératoire. Le groupe de patients atteints d’un oligodendrogliome an aplasique, de même que les patients ayant reçu un traitement agressif, avaient une mortalité plus basse et ont maintenu de meilleurs scores IFK pendant la période d’observation. Les facteurs qui prédisaient le mieux l’état fonctionnel étaient l’âge, l’IFK avant le traitement et le type de traitement reçu. Les facteurs les plus importants associés à la survie étaient l’âge, la sévérité des cormobidités, l’IFK avant traitement, le présence de confusion, le diagnostic anatomopathologique et le type de traitement reçu.

Conclusion:

Chez les patients atteints de gliomes malins, on observe un meilleur état fonctionnel et une survie plus longue chez ceux qui sont plus jeunes, qui ont un meilleur état fonctionnel au moment du diagnostic et qui reçoivent un traitement multimodal agressif. L’effet d’un traitement multimodal sur l’état fonctionnel des patients devra être confirmé par un essai clinique contrôlé randomisé.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 32 , Issue 1 , February 2005 , pp. 50 - 56
Copyright
Copyright © The Canadian Journal of Neurological 2014

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