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. 2007 Jun 20;25(18):2601-6.
doi: 10.1200/JCO.2006.08.1661.

Prognostic factors for survival in adult patients with recurrent glioma enrolled onto the new approaches to brain tumor therapy CNS consortium phase I and II clinical trials

Kathryn A Carson  1 , Stuart A Grossman, Joy D Fisher, Edward G Shaw
Affiliations

Prognostic factors for survival in adult patients with recurrent glioma enrolled onto the new approaches to brain tumor therapy CNS consortium phase I and II clinical trials

Kathryn A Carson et al. J Clin Oncol. .

Abstract

Purpose: Prognostic factor analyses have proven useful in predicting outcome in patients with newly diagnosed malignant glioma. Similar analyses in patients with recurrent glioma could affect the design and conduct of clinical trials substantially.

Patients and methods: Between 1995 and 2002, 333 adults with recurrent gliomas were enrolled onto 10 phase I or II trials of systemic or local therapy. The studies had similar inclusion criteria and were conducted within the New Approaches to Brain Tumor Therapy CNS Consortium. Ninety-three percent of the patients have died. Cox proportional hazards (PH) regression and recursive partitioning analysis (RPA) were performed to identify prognostic factors.

Results: Factors associated with an increased risk of death were increased age, lower Karnofsky performance score (KPS), initial and on-study histologies of glioblastoma multiforme (GBM), corticosteroid use, shorter time from original diagnosis to recurrence, and tumor outside frontal lobe. The final PH model included initial histology of GBM (relative risk [RR] = 2.01), 10-year increase in age (RR = 1.23), KPS less than 80 (RR = 1.54), and corticosteroid use (RR = 1.49). RPA resulted in seven classes. Median survival time was poorest in non-GBM patients with KPS less than 80 or GBM patients, age 50 years, corticosteroid use (4.4 months; 95% CI, 3.6 to 5.4 months); median survival was best in patients with initial histology other than GBM with KPS 80 and tumor confined to the frontal lobe (25.7 months; 95% CI, 18.7 to 52.5), and was 7.0 months (95% CI, 6.2 to 8.0 months) for all patients.

Conclusion: Initial histology, age, KPS, and corticosteroid use are prognostic for survival in recurrent glioma patients. To allow comparisons across phase II trials, enrollment criteria may need to be restricted.

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Figures

Figure 1
Figure 1
The hazard rate and 95% confidence interval for the 10 protocols included in this study. The size of the diamond is proportional to the number of patients in the trial.
Figure 2
Figure 2
Results of the recursive partitioning analysis (RPA). The terminal nodes are represented by squares, which contain the number of deaths out of the number of patients in those nodes, as well as the median survival time in months. The RPA classes are numbered below the squares.
Figure 3
Figure 3
Kaplan-Meier survival curves for the 5 different classes from the RPA. The curves were truncated at 60 months.
See this image and copyright information in PMC

Comment in

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