The Influence Of The Time Of Postoperative Chemotherapy And Age On Prognosis For Newly Diagnosed High-grade Glioma

PurposeGlioblastoma multiforme (GBM) is the most common primary malignant braintumor in adults. Current treatment options for patients with GBM include maximalsafe tumor resection, followed by radiotherapy and cocurrent and adjuvanttemozolomide (TMZ). However, whether the early postoperative adjuvantchemotherapy with TMZ may provide a better survival benefit is not clear, hence, thisstudy retrospectively analyzed a group that received chemotherapy of TMZ before thetwo postoperative weeks, to wish to gain the influence of the time of postoperativechemotherapy of TMZ on survival for GBM.MethodClinical data of75patients with histologically proven GBM at the FirstAffiliated Hospital of Fujian Medical University during March2007to December2012were retrospectively reviewed and analyzed. The overall survival was analyzedby the Kaplan–Meier method and the influencing factors screened by the Coxproportional hazard model.ResultsThe univariate analysis revealed the age (P=0.005), chemotherapy(P=0.001), thetime of postoperative chemotherapy (P=0.004), radiotherapy (P=0.023) andpreoperative Karnofsky Performance Scale (KPS)(P=0.004) were significantlycorrelated with patients’ overall survival. The median survival of patients≤50yearsand＞50years were20.0months (95%CI:10.900-29.100) and11.0months(95%CI:9.188-12.812), respectively (P＜0.023). The median survival of patients receiving TMZ before the two postoperative weeks, on the two postoperative weeksand no chemotherapy were16.0months (95%CI:11.167-20.833),12.0months(95%CI:9.557-14.433) and7.0months (95%CI:5.936-8.064), respectively (P=0.001).The median survival of patients receiving regular chemotherapy, irregularchemotherapy and no chemotherapy were20.0months (95%CI:13.351-26.649),10.0months (95%CI:7.009-12.991) and7.0months (95%CI:5.936-8.064), respectively(P=0.001). The median survival of patients receiving radiotherapy and noradiotherapy were18.0months (95%CI:13.414-22.586) and9.0months(95%CI:6.739-11.261), respectively (P=0.023). The median survival of patients’preoperative KPS≥80and＜80were13.0months (95%CI:5.008-20.992) and9.0months (95%CI:5.425-12.575), respectively(P=0.004). Cox multivariate analysisindicated age (P=0.029),chemotherapy (P=0.001),preoperative KPS (P=0.006) werethe independent factors influencing the overall survival.ConclusionsThe time receiving TMZ before the two postoperative weeks may provide abetter survival benefit, but it is not a independent factor. In addition, age,chemotherapy, preoperative KPS were the independent factors influencing the overallsurvival of the GBM PurposeThe influence of age on the prognosis of patients with glioma has been paidgreat attention for people, but whether age can affect the prognosis as an independentfactor is still controversial. Moreover, there is considerable discrepancy between theage-related studies in terms of the division standard of age, and no studies havereported the most appropriate methods of dividing age in judging patients’ prognosis.The aim of this study was to assess the influence of age on the prognosis in patientswith high-grade gliomas (HGGs) using different division standards.MethodClinical data of125patients with histologically proven HGGs who underwenttumor resection in surgically amenable areas at the First Affiliated Hospital of FujianMedical University during June2002to June2012were retrospectively reviewed, andanalyzed the influence of age on prognosis with three different division standards, age≤50years vs.＞50years,≤60years vs.＞60years,≤45years vs.45-65years vs.60years, respectively. The overall survival was analyzed by the Kaplan–Meiermethod and the influencing factors screened by the Cox proportional hazard model.ResultsUnivariate analysis results showed that age was associated with overall survival(OS) when grouped as fallows: age≤50years and＞50years (P＜0.001),≤60yearsand＞60years (P＜0.001) or≤45years,45-65years and＞60years (P=0.001);tumor pathological grade (P＜0.001) was also related to OS. the median OS of femalewas28.0months (95%CI,5.407to50.593months), longer than15.0months (95%CI,9.771to20.229months) of male(P=0.030); the median OS of patients receivingregular postoperative chemotherapy was28.0months (95%CI,1.134to54.866months), longer than11.0months (95%CI,7.553to14.447) of patients withoutpostoperative chemotherapy and21.0months (95%CI,10.175to31.825months) ofthose receiving irregular chemotherapy(P=0.001);the median OS of patientsreceiving postoperative radiotherapy was28.0months (95%CI,15.104to40.896months), longer than11.0months (95%CI,8.491to13.509) of those withoutradiotherapy(P <0.0001). Multivariate analysis results indicated that age (P <0.0001) was an independent predictor of OS when grouped as fallows:≤50years and＞50years, in addition to tumor pathological grade (P <0.0001) and chemotherapy (P=0.001).ConclusionsThe appropriate division standard of age in judging the prognosis of patients withHGG in hemisphere was age≤50years vs.＞50years. In addition, tumorpathological grade and chemotherapy were independent factors affecting overallsurvival of patients with HGGs.