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Open Access 01-12-2022 | Glioblastoma | Research article

Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor?

Authors: Melanie Barz, Stefanie Bette, Insa Janssen, A. Kaywan Aftahy, Thomas Huber, Friederike Liesche-Starnecker, Yu-Mi Ryang, Benedikt Wiestler, Stephanie E. Combs, Bernhard Meyer, Jens Gempt

Published in: BMC Neurology | Issue 1/2022

Abstract

Background

For recurrent glioblastoma (GB) patients, several therapy options have been established over the last years such as more aggressive surgery, re-irradiation or chemotherapy. Age and the Karnofsky Performance Status Scale (KPSS) are used to make decisions for these patients as these are established as prognostic factors in the initial diagnosis of GB. This study’s aim was to evaluate preoperative patient comorbidities by using the age-adjusted Charlson Comorbidity Index (ACCI) as a prognostic factor for recurrent GB patients.

Methods

In this retrospective analysis we could include 123 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (43 females, 80 males, mean age 57 years (range 21–80 years)). Preoperative age, sex, ACCI, KPSS and adjuvant treatment regimes were recorded for each patient. Extent of resection (EOR) was recorded as a complete/incomplete resection of the contrast-enhancing tumor part.

Results

Median overall survival (OS) was 9.0 months (95% CI 7.1–10.9 months) after first re-resection. Preoperative KPSS > 80% (P < 0.001) and EOR (P = 0.013) were associated with significantly improved survival in univariate analysis. Including these factors in multivariate analysis, preoperative KPSS < 80 (HR 2.002 [95% CI: 1.246–3.216], P = 0.004) and EOR are the only significant prognostic factor (HR 1.611 [95% CI: 1.036–2.505], P = 0.034). ACCI was not shown as a prognostic factor in univariate and multivariate analyses.

Conclusion

For patients with surgery for recurrent glioblastoma, the ACCI does not add further information about patient’s prognosis besides the well-established KPSS and extent of resection.

Barnholtz-Sloan JS, Ostrom QT, Cote D. Epidemiology of brain tumors. Neurol Clin. 2018;36(3):395–419. https://doi.org/10.1016/j.ncl.2018.04.001.CrossRefPubMed

Ostrom QT, Cote DJ, Ascha M, Kruchko C, Barnholtz-Sloan JS. Adult Glioma incidence and survival by race or ethnicity in the United States from 2000 to 2014. JAMA Oncol. 2018;4(9):1254–62. https://doi.org/10.1001/jamaoncol.2018.1789.CrossRefPubMedPubMedCentral

Minniti G, Amelio D, Amichetti M, Salvati M, Muni R, Bozzao A, et al. Patterns of failure and comparison of different target volume delineations in patients with glioblastoma treated with conformal radiotherapy plus concomitant and adjuvant temozolomide. Radiother Oncol. 2010;97(3):377–81. https://doi.org/10.1016/j.radonc.2010.08.020.CrossRefPubMed

Woehrer A, Bauchet L, Barnholtz-Sloan JS. Glioblastoma survival: has it improved? Evidence from population-based studies. Curr Opin Neurol. 2014;27(6):666–74. https://doi.org/10.1097/WCO.0000000000000144.CrossRefPubMed

Palmer JD, Bhamidipati D, Shukla G, Sharma D, Glass J, Kim L, et al. Rapid early tumor progression is prognostic in Glioblastoma patients. Am J Clin Oncol. 2019;42(5):481–6. https://doi.org/10.1097/COC.0000000000000537.CrossRefPubMed

Hervey-Jumper SL, Berger MS. Reoperation for recurrent high-grade glioma: a current perspective of the literature. Neurosurgery. 2014;75(5):491–9; discussion 8-9. https://doi.org/10.1227/NEU.0000000000000486.CrossRefPubMed

Ringel F, Pape H, Sabel M, Krex D, Bock HC, Misch M, et al. Clinical benefit from resection of recurrent glioblastomas: results of a multicenter study including 503 patients with recurrent glioblastomas undergoing surgical resection. Neuro-Oncology. 2016;18(1):96–104. https://doi.org/10.1093/neuonc/nov145.CrossRefPubMed

Macedo M, Wenger C, Salvador R, Fernandes SR, Miranda PC. Investigating an alternative ring design of transducer arrays for tumor treating fields (TTFields). Conf Proc IEEE Eng Med Biol Soc. 2016;2016:5168–71. https://doi.org/10.1109/EMBC.2016.7591891.CrossRef

Karnofsky DA, Burchenal JH, et al. Experimental observations on the effects of the nitrogen mustards on neoplastic tissues. Cancer Res. 1947;7(1):50.PubMed

10.

Sacko A, Hou MM, Temgoua M, Alkhafaji A, Marantidou A, Belin C, et al. Evolution of the Karnosky performance status throughout life in glioblastoma patients. J Neuro-Oncol. 2015;122(3):567–73. https://doi.org/10.1007/s11060-015-1749-6.CrossRef

11.

Suchorska B, Jansen NL, Linn J, Kretzschmar H, Janssen H, Eigenbrod S, et al. Biological tumor volume in 18FET-PET before radiochemotherapy correlates with survival in GBM. Neurology. 2015;84(7):710–9. https://doi.org/10.1212/WNL.0000000000001262.CrossRefPubMed

12.

Yong RL, Wu T, Mihatov N, Shen MJ, Brown MA, Zaghloul KA, et al. Residual tumor volume and patient survival following reoperation for recurrent glioblastoma. J Neurosurg. 2014;121(4):802–9. https://doi.org/10.3171/2014.6.JNS132038.CrossRefPubMed

13.

Bergqvist J, Iderberg H, Mesterton J, Henriksson R. The effects of clinical and sociodemographic factors on survival, resource use and lead times in patients with high-grade gliomas: a population-based register study. J Neuro-Oncol. 2018;139(3):599–608. https://doi.org/10.1007/s11060-018-2899-0.CrossRef

14.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83. https://doi.org/10.1016/0021-9681(87)90171-8.CrossRefPubMed

15.

Shuvy M, Zwas DR, Keren A, Gotsman I. Prevalence and impact of concomitant malignancy on outcomes among ambulatory heart failure population. Eur J Clin Investig. 2021;51(2):e13373. https://doi.org/10.1111/eci.13373.CrossRef

16.

Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47(11):1245–51. https://doi.org/10.1016/0895-4356(94)90129-5.CrossRefPubMed

17.

Martinez C, Jorge AS, Pereira A, Moreno M, Nunez J, Gayoso J, et al. Comorbidities, not age, are predictive of survival after autologous hematopoietic cell transplantation for relapsed/refractory Hodgkin's lymphoma in patients older than 50 years. Ann Hematol. 2017;96(1):9–16. https://doi.org/10.1007/s00277-016-2832-6.CrossRefPubMed

18.

Tanvetyanon T, Padhya T, McCaffrey J, Zhu W, Boulware D, Deconti R, et al. Prognostic factors for survival after salvage reirradiation of head and neck cancer. J Clin Oncol. 2009;27(12):1983–91. https://doi.org/10.1200/JCO.2008.20.0691.CrossRefPubMed

19.

Mayr R, May M, Burger M, Martini T, Pycha A, Dechet C, et al. The Charlson comorbidity index predicts survival after disease recurrence in patients following radical cystectomy for urothelial carcinoma of the bladder. Urol Int. 2014;93(3):303–10. https://doi.org/10.1159/000362421.CrossRefPubMed

20.

General assembly of the world medical a. World medical association declaration of Helsinki: ethical principles for medical research involving human subjects. J Am Coll Dent. 2014;81(3):14–8.

21.

Wen PY, Macdonald DR, Reardon DA, Cloughesy TF, Sorensen AG, Galanis E, et al. Updated response assessment criteria for high-grade gliomas: response assessment in neuro-oncology working group. J Clin Oncol. 2010;28(11):1963–72. https://doi.org/10.1200/JCO.2009.26.3541.CrossRefPubMed

22.

Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131(6):803–20. https://doi.org/10.1007/s00401-016-1545-1.CrossRefPubMed

23.

von Rosenstiel C, Wiestler B, Haller B, Schmidt-Graf F, Gempt J, Bettstetter M, et al. Correlation of the quantitative level of MGMT promoter methylation and overall survival in primary diagnosed glioblastomas using the quantitative MethyQESD method. J Clin Pathol. 2020;73(2):112–5. https://doi.org/10.1136/jclinpath-2019-206104.CrossRef

24.

Stupp R, Hegi ME, Mason WP, van den Bent MJ, Taphoorn MJ, Janzer RC, et al. Effects of radiotherapy with concomitant and adjuvant temozolomide versus radiotherapy alone on survival in glioblastoma in a randomised phase III study: 5-year analysis of the EORTC-NCIC trial. Lancet Oncol. 2009;10(5):459–66. https://doi.org/10.1016/S1470-2045(09)70025-7.CrossRefPubMed

25.

Bloch O, Han SJ, Cha S, Sun MZ, Aghi MK, McDermott MW, et al. Impact of extent of resection for recurrent glioblastoma on overall survival: clinical article. J Neurosurg. 2012;117(6):1032–8. https://doi.org/10.3171/2012.9.JNS12504.CrossRefPubMed

26.

Rusthoven KE, Olsen C, Franklin W, Kleinschmidt-DeMasters BK, Kavanagh BD, Gaspar LE, et al. Favorable prognosis in patients with high-grade glioma with radiation necrosis: the University of Colorado reoperation series. Int J Radiat Oncol Biol Phys. 2011;81(1):211–7. https://doi.org/10.1016/j.ijrobp.2010.04.069.CrossRefPubMed

27.

Harsh GRt, Levin VA, Gutin PH, Seager M, Silver P, Wilson CB. Reoperation for recurrent glioblastoma and anaplastic astrocytoma. Neurosurgery. 1987;21(5):615–21. https://doi.org/10.1227/00006123-198711000-00002.CrossRef

28.

Barker FG 2nd, Chang SM, Gutin PH, Malec MK, McDermott MW, Prados MD, et al. Survival and functional status after resection of recurrent glioblastoma multiforme. Neurosurgery. 1998;42(4):709–20; discussion 20-3. https://doi.org/10.1097/00006123-199804000-00013.CrossRefPubMed

29.

Park JK, Hodges T, Arko L, Shen M, Dello Iacono D, McNabb A, et al. Scale to predict survival after surgery for recurrent glioblastoma multiforme. J Clin Oncol. 2010;28(24):3838–43. https://doi.org/10.1200/JCO.2010.30.0582.CrossRefPubMedPubMedCentral

30.

Woodworth GF, Garzon-Muvdi T, Ye X, Blakeley JO, Weingart JD, Burger PC. Histopathological correlates with survival in reoperated glioblastomas. J Neuro-Oncol. 2013;113(3):485–93. https://doi.org/10.1007/s11060-013-1141-3.CrossRef

31.

Montemurro N, Perrini P, Blanco MO, Vannozzi R. Second surgery for recurrent glioblastoma: a concise overview of the current literature. Clin Neurol Neurosurg. 2016;142:60–4. https://doi.org/10.1016/j.clineuro.2016.01.010.CrossRefPubMed

32.

Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, et al. Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma outcome project. J Neurosurg. 2003;98(6):1175–81. https://doi.org/10.3171/jns.2003.98.6.1175.CrossRefPubMed

33.

Roth P, Gramatzki D, Weller M. Management of Elderly Patients with Glioblastoma. Curr Neurol Neurosci Rep. 2017;17(4):35. https://doi.org/10.1007/s11910-017-0740-3.CrossRefPubMed

34.

Perry JR, Laperriere N, O'Callaghan CJ, Brandes AA, Menten J, Phillips C, et al. Short-course radiation plus Temozolomide in elderly patients with Glioblastoma. N Engl J Med. 2017;376(11):1027–37. https://doi.org/10.1056/NEJMoa1611977.CrossRefPubMed

35.

Felsberg J, Rapp M, Loeser S, Fimmers R, Stummer W, Goeppert M, et al. Prognostic significance of molecular markers and extent of resection in primary glioblastoma patients. Clin Cancer Res. 2009;15(21):6683–93. https://doi.org/10.1158/1078-0432.CCR-08-2801.CrossRefPubMed

36.

Yang CC, Chen PC, Hsu CW, Chang SL, Lee CC. Validity of the age-adjusted charlson comorbidity index on clinical outcomes for patients with nasopharyngeal cancer post radiation treatment: a 5-year nationwide cohort study. PLoS One. 2015;10(1):e0117323. https://doi.org/10.1371/journal.pone.0117323.CrossRefPubMedPubMedCentral

37.

Boje CR, Dalton SO, Primdahl H, Kristensen CA, Andersen E, Johansen J, et al. Evaluation of comorbidity in 9388 head and neck cancer patients: a national cohort study from the DAHANCA database. Radiother Oncol. 2014;110(1):91–7. https://doi.org/10.1016/j.radonc.2013.11.009.CrossRefPubMed

38.

Pessina F, Navarria P, Cozzi L, Tomatis S, Riva M, Ascolese AM, et al. Role of surgical resection in recurrent glioblastoma: prognostic factors and outcome evaluation in an observational study. J Neuro-Oncol. 2017;131(2):377–84. https://doi.org/10.1007/s11060-016-2310-y.CrossRef

39.

Perrini P, Gambacciani C, Weiss A, Pasqualetti F, Delishaj D, Paiar F, et al. Survival outcomes following repeat surgery for recurrent glioblastoma: a single-center retrospective analysis. J Neuro-Oncol. 2017;131(3):585–91. https://doi.org/10.1007/s11060-016-2330-7.CrossRef

40.

Tully PA, Gogos AJ, Love C, Liew D, Drummond KJ, Morokoff AP. Reoperation for recurrent Glioblastoma and its association with survival benefit. Neurosurgery. 2016;79(5):678–89. https://doi.org/10.1227/NEU.0000000000001338.CrossRefPubMed

41.

Azoulay M, Santos F, Shenouda G, Petrecca K, Oweida A, Guiot MC, et al. Benefit of re-operation and salvage therapies for recurrent glioblastoma multiforme: results from a single institution. J Neuro-Oncol. 2017;132(3):419–26. https://doi.org/10.1007/s11060-017-2383-2.CrossRef

42.

Mendenhall WM, Morris CG, Amdur RJ, Hinerman RW, Mancuso AA. Parameters that predict local control after definitive radiotherapy for squamous cell carcinoma of the head and neck. Head Neck. 2003;25(7):535–42. https://doi.org/10.1002/hed.10253.CrossRefPubMed

43.

Kim J, Kim S, Albergotti WG, Choi PA, Kaplan DJ, Abberbock S, et al. Selection of ideal candidates for surgical salvage of head and neck squamous cell carcinoma: effect of the Charlson-age comorbidity index and oncologic characteristics on 1-year survival and hospital course. JAMA Otolaryngol Head Neck Surg. 2015;141(12):1059–65. https://doi.org/10.1001/jamaoto.2015.2158.CrossRefPubMedPubMedCentral

44.

Chang JH, Wu CC, Yuan KS, Wu ATH, Wu SY. Locoregionally recurrent head and neck squamous cell carcinoma: incidence, survival, prognostic factors, and treatment outcomes. Oncotarget. 2017;8(33):55600–12. https://doi.org/10.18632/oncotarget.16340.CrossRefPubMedPubMedCentral

Title: Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor?
Authors: Melanie Barz
Stefanie Bette
Insa Janssen
A. Kaywan Aftahy
Thomas Huber
Friederike Liesche-Starnecker
Yu-Mi Ryang
Benedikt Wiestler
Stephanie E. Combs
Bernhard Meyer
Jens Gempt
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Glioblastoma
Glioblastoma
Glioblastoma
Published in: BMC Neurology / Issue 1/2022
Electronic ISSN: 1471-2377
DOI: https://doi.org/10.1186/s12883-021-02532-x

2024 ASCO Annual Meeting

Springer Medicine

Age-adjusted Charlson comorbidity index in recurrent glioblastoma: a new prognostic factor?

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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