Article
Charlston Comorbidity Index (CCI) as an additional prognostic factor for glioblastoma patients
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Published: | June 9, 2017 |
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Objective: Many established prognostic factors for glioblastoma (GB) patients like histopathological diagnosis, molecular status and extent of resection can only be assessed postoperatively. The only well-known prognostic clinical factors that can be obtained preoperatively areage and the Karnofsky performance scale (KPS). This study aimed to optimize preoperative diagnostics and to find other prognostic factors for glioblastoma patients.
Methods: We retrospectively included 223 patients (92 female, 131 male), mean age 64.0 years (+/-13.6), with surgery for a newly diagnosed GB from May 2006 to December 2015 with available Charlson comorbidity index (CCI) including data about cardiovascular diseases or other relevant comorbidities. Preoperative age, sex, comorbidity status quantified by the CCI,KPS and adjuvant treatment regimes were recorded for each patient. Pre- and postoperative tumor volume was manually segmented.
Results: The median overall survival was 9.7months (95% confidence interval (CI) 7.1-12.3)). Preoperative KPS > 70% (P<0.001), CCI <5 (P=0.001) and age <60years (P<0.001) were associated with significantly improved survival in univariate analysis. Including these preoperative factors only in multivariate analysis, preoperative KPS (≥80/<80) is the only significant prognostic factor (HR 2.57 [1.84-3.58], P<0.001), whereas CCI (<5/≥5) missed statistical significance (HR 1.32 [0.89-1.95], P=0.172). Including also other well-known prognostic factors like MGMT-status and extent of resection (EOR), preoperative KPS showed statistical significance (P<0.001), whereas CCI did not reached significance (P=0.515). Subgroup analysis for patients ≥ 60 years showed that beneath preoperative KPS, CCI (<5/≥5) is a prognostic factor (HR 1.88 [1.11-3.19], P=0.029). Including also MGMT status and EOR in this subgroup analysis, CCI missed statistical significance (P=0.220).
Conclusion: Besides established prognostic factors like age and KPS CCI could be a valuable additional factor in preoperative estimation of individuals’ prognosis especially for older patients.