Initial cognitive impairment predicts shorter survival of patients with glioblastoma.
cognitive functions
epilepsy
glioblastoma
neuro-oncology
radiation
seizures
survival
temozolomide
Journal
Acta neurologica Scandinavica
ISSN: 1600-0404
Titre abrégé: Acta Neurol Scand
Pays: Denmark
ID NLM: 0370336
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
24
08
2021
received:
21
01
2021
accepted:
26
08
2021
pubmed:
14
9
2021
medline:
15
12
2021
entrez:
13
9
2021
Statut:
ppublish
Résumé
Seizures as presenting symptom of glioblastoma (GBM) are known to predict prolonged survival, whereas the clinical impact of other initial symptoms is less known. Our main objective was to evaluate the influence of different presenting symptoms on survival in a clinical setting. We also assessed lead times, tumour size and localization. Medical records of 189 GBM patients were reviewed regarding the first medical appointment, presenting symptom/s, date of diagnostic radiology and survival. Tumour size, localization and treatment data were retrieved. Overall survival was calculated using Kaplan-Meier and Mann-Whitney U test. Cox regression was used for risk estimation. Cognitive impairment as the initial symptom was often misinterpreted in primary health care leading to a delayed diagnosis. Initial global symptoms (66% of all patients) were associated with reduced survival compared to no global symptoms (median 8.4 months vs. 12.6 months). Those with the most common cognitive dysfunctions: change of behaviour, memory impairment and/or disorientation had a reduced median survival to 6.4 months. In contrast, seizures (32%) were associated with longer survival (median 11.2 months vs. 8.3 months). Global symptoms were associated with larger tumours than seizures, but tumour size had no linear association with survival. The setting of the first medical appointment was evenly distributed between primary health care and emergency units. Patients with GBM presenting with cognitive symptoms are challenging to identify, have larger tumours and reduced survival. In contrast, epileptic seizures as the first symptom are associated with longer survival and smaller tumours.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
94-101Subventions
Organisme : Gustav Lindholm Foundation for malignant brain tumors
Organisme : Futurum
Informations de copyright
© 2021 The Authors. Acta Neurologica Scandinavica published by John Wiley & Sons Ltd.
Références
Socialstyrelsen. Swedish Cancer Register. 2021 [cited 2021 March 25 2021]; Available from: https://socialstyrelsen.se/en/statistics-and-data/registers/alla-register/swedish-cancer-register/.
Burger PC, Vogel FS, Green SB, Strike TA. Glioblastoma multiforme and anaplastic astrocytoma. Pathologic criteria and prognostic implications. Cancer. 1985;56(5):1106-1111.
Johnson DR, Galanis E. Medical management of high-grade astrocytoma: current and emerging therapies. Semin Oncol. 2014;41(4):511-522.
Bruhn H, Strandéus M, Milos P, Hallbeck M, Vrethem M, Lind J. Improved survival of Swedish glioblastoma patients treated according to Stupp. Acta Neurol Scand. 2018;138(4):332-337.
Lamborn KR, Chang SM, Prados MD. Prognostic factors for survival of patients with glioblastoma: recursive partitioning analysis. Neuro Oncol. 2004;6(3):227-235.
Stark AM, van de Bergh J, Hedderich J, Mehdorn HM, Nabavi A. Glioblastoma: clinical characteristics, prognostic factors and survival in 492 patients. Clin Neurol Neurosurg. 2012;114(7):840-845.
Ahmadloo N, Kani A-A, Mohammadianpanah M, et al. Treatment outcome and prognostic factors of adult glioblastoma multiforme. J Egypt Natl Canc Inst. 2013;25(1):21-30.
Audureau E, Chivet A, Ursu R, et al. Prognostic factors for survival in adult patients with recurrent glioblastoma: a decision-tree-based model. J Neurooncol. 2018;136(3):565-576.
Nestler U, Lutz K, Pichlmeier U, et al. Anatomic features of glioblastoma and their potential impact on survival. Acta Neurochir (Wien). 2015;157(2):179-186.
Hallaert G, Pinson H, Van den Broecke C, et al. Subventricular zone contacting glioblastoma: tumor size, molecular biological factors and patient survival. Acta Oncol. 2020;59(12):1474-1479.
IJzerman-Korevaar M, Snijders TJ, de Graeff A, Teunissen SCCM, de Vos FYF. Prevalence of symptoms in glioma patients throughout the disease trajectory: A systematic review. J Neurooncol. 2018;140(3):485-496.
Faguer R, Tanguy J-Y, Rousseau A, Clavreul A, Menei P. Early presentation of primary glioblastoma. Neurochirurgie. 2014;60(4):188-193.
Dührsen L, Sauvigny T, Ricklefs FL, et al. Seizures as presenting symptom in patients with glioblastoma. Epilepsia. 2019;60(1):149-154.
Posti JP, Bori M, Kauko T, et al. Presenting symptoms of glioma in adults. Acta Neurol Scand. 2015;131(2):88-93.
Valentinis L, Tuniz F, Valent F, et al. Headache attributed to intracranial tumours: a prospective cohort study. Cephalalgia. 2010;30(4):389-398.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277-1288.
Ellingson BM, Wen PY, Cloughesy TF. Modified criteria for radiographic response assessment in glioblastoma clinical trials. Neurotherapeutics. 2017;14(2):307-320.
Ghosh D. Incorporating the empirical null hypothesis into the Benjamini-Hochberg procedure. Stat Appl Genet Mol Biol. 2012;11(4).
Noll KR, Sullaway CM, Wefel JS. Depressive symptoms and executive function in relation to survival in patients with glioblastoma. J Neurooncol. 2019;142(1):183-191.
Johnson DR, Sawyer AM, Meyers CA, O'Neill BP, Wefel JS. Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma. Neuro Oncol. 2012;14(6):808-816.
Johnson DR, Wefel JS. Relationship between cognitive function and prognosis in glioblastoma. CNS Oncol. 2013;2(2):195-201.
Meyers CA, Hess KR, Yung WKA, Levin VA. Cognitive function as a predictor of survival in patients with recurrent malignant glioma. J Clin Oncol. 2000;18(3):646-650.
Hansen S, Rasmussen BK, Laursen RJ, et al. Treatment and survival of glioblastoma patients in Denmark: The Danish neuro-oncology registry 2009-2014. J Neurooncol. 2018;139(2):479-489.
Yuile P, Dent O, Cook R, Biggs M, Little N. Survival of glioblastoma patients related to presenting symptoms, brain site and treatment variables. J Clin Neurosci. 2006;13(7):747-751.
Salander P. Pathways from symptoms to medical care: a descriptive study of symptom development and obstacles to early diagnosis in brain tumour patients. Fam Pract. 1999;16(2):143-148.
Dobran M, Nasi D, Chiriatti S, et al. Prognostic Factors in Glioblastoma: Is There a Role for Epilepsy? Neurol Med Chir (Tokyo). 2018;58(3):110-115.
Lu VM, Jue TR, Phan K, McDonald KL. Quantifying the prognostic significance in glioblastoma of seizure history at initial presentation: A systematic review and meta-analysis. Clin Neurol Neurosurg. 2018;164:75-80.
Berendsen S, Varkila M, Kroonen J, et al. Prognostic relevance of epilepsy at presentation in glioblastoma patients. Neuro Oncol. 2016;18(5):700-706.
Flanigan PM, Jahangiri A, Kuang R, et al. Improved Survival with Decreased Wait Time to Surgery in Glioblastoma Patients Presenting with Seizure. Neurosurgery. 2017;81(5):824-833.
Paldor I, Pearce FC, Drummond KJ, Kaye AH. Frontal glioblastoma multiforme may be biologically distinct from non-frontal and multilobar tumors. J Clin Neurosci. 2016;34:128-132.
Fabbro-Peray P, Zouaoui S, Darlix A, et al. Association of patterns of care, prognostic factors, and use of radiotherapy-temozolomide therapy with survival in patients with newly diagnosed glioblastoma: a French national population-based study. J Neurooncol. 2019;142(1):91-101.
Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007;114(2):97-109.
Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: A summary. Acta Neuropathol. 2016;131(6):803-820.