The Prognostic Assessment Of Reoperation For Recurrent Glioblastoma

ObjectivesIn order to determine the impact of reoperation for recurrent glioblastoma and to investigate the prognostic predictors, we performed univariate and multivariate analysis of the selected clinical characteristics, and explored the feasibility of making reoperation into the standard treatment of recurrent glioblastoma.MethodsAll patients reoperated in Xiangya Hospital for recurrent disease and diagnosed with glioblastoma during the period January2006and April2014were retrospectively reviewed in this study. According to the trial entry criteria, selected characteristics of the whole18patients were reviewed retrospectively. Meanwhile,15patients diagnosed with primary glioblasmtoma who did not choose reoperation when recurred were selected to be the control group. Kaplan-Meier univariate analysis and COX multivariate analysis were performed to evaluate the impact of the reoperation for the patients with recurrent glioblastoma, and to investigate the prognostic predictorsResults1. Age at reoperation ranged between13years and61years, and the median age was39years.12of patients suffered the tumor at left cerebral hemisphere,5at left cerebral hemisphere and1at cerebellum; Most were recurrence in situ instead of distant metastasis.10of patients were diagnosed with GBM at initial surgery.13of patients underwent chemoradiotherapy after initial surgery, and5received surgery alone. None died of the complications of reoperation, such as hemorrhage, severe infection and severe encephaledema.8of patients improved their neurological performance status,8of no change and2of decreased neurological performance status.2. Median OS of the reoperation group was20.1month, and patients diagnosed with GBM at initial surgery had the median OS of18.4month, meanwhile that of the control group was13.7month, which was statistically different from that in reoperation group (p=0.009).3. Median OS after reoperation for the recurrent glioblastoma patients was8.2month, of which patients diagnosed with GBM at initial surgery has the median OS of8.1month.4. At univariate analysis associated with median OS, age at reoperation, histology at initial surgery and the internal period between two surgeries might be the prognostic predictors. At multivariate analysis associated with median OS, histology at initial surgery was the significant factor for the prognosis (p=0.042)5. At univariate analysis associated with median OS after reoperation, chemoradiotherapy after initial surgery, the internal period between two surgeries and the extent of resection at reoperation might be the prognostic predictors. At multivariate analysis associated with median OS after reoperation, the extent of resection at reoperation was the significant factor for the prognosis (p=0.010)Conclusions1. Retrospective analysis of patients with recurrent glioblastoma for single center showed that reoperation prolonged the survival time to some extent.2. The overall survival of the recurrent glioblastoma patients with reoperation was correlated with the histology at initial surgery, age at reoperation, and the internal period between two surgeries. The histology at initial surgery may be the independent prognostic factor.3. The overall survival after reoperation for the patients with recurrent glioblastoma was affected with chemoradiotherapy after initial surgery, the internal period between two surgeries and the extent of resection at reoperation, and the extent of resection at reoperation may be the independent prognostic factor.