Backround: 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 133 patients with surgery for primary recurrence of GB from January 2007 until December 2016 (49 females, 84 males, mean age 58 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 (including biopsy) resection of the contrast-enhancing tumor part.
Results: Median overall survival (OS) after initial diagnosis was 20.0 months (95% confidence interval (CI) 17.2-22.9)) and 9.0 months (95% CI 7.1-10.9 months) after first re-resection. Preoperative KPSS > 80% (P<0.001) and ACCI <7 (P=0.020) were associated with significantly improved survival in univariate analysis. Including these preoperative factors in multivariate analysis, preoperative KPSS (≥80/<80) is the only significant prognostic factor (HR 1.934[1.3-3.0], P=0.003), whereas ACCI (<7/≥7) missed statistical significance (HR 1.608[0.8-3.1], P=0.154).
Conclusion: ACCI might be an additional prognostic factor for patients with recurrent glioblastoma, especially in those with many comorbidities. However, besides the well-established KPSS, the ACCI does not add further information about patients’ prognosis.