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. 2025 Jan 11;15(1):1750.
doi: 10.1038/s41598-025-85339-x.

Factors involved in maintaining Karnofsky Performance Status (≥ 50%) in glioblastoma, IDH-wildtype patients treated with temozolomide and radiotherapy

Shigeo Ohba  1 , Takao Teranishi  2 , Kazuyasu Matsumura  2 , Masanobu Kumon  2 , Daijiro Kojima  2 , Eiji Fujiwara  2 , Kazutaka Nakao  2 , Kiyonori Kuwahara  2 , Kazuhiro Murayama  3 , Eriel Sandika Pareira  4 , Seiji Yamada  5 , Masahiro Joko  2 , Shunsuke Nakae  2 , Jun Muto  2 , Yuya Nishiyama  2 , Kazuhide Adachi  2 , Hikaru Sasaki  6 , Masato Abe  7 , Mitsuhiro Hasegawa  2 , Yuichi Hirose  2
Affiliations

Factors involved in maintaining Karnofsky Performance Status (≥ 50%) in glioblastoma, IDH-wildtype patients treated with temozolomide and radiotherapy

Shigeo Ohba et al. Sci Rep. .

Abstract

Karnofsky Performance Status (KPS) is a widely used scale to assess performance status. KPS ≥ 50% implies that patients can live at home. Therefore, maintaining KPS ≥ 50% is important to improve the quality of life of patients with glioblastoma, whose median survival is less than 2 years. This study aimed to identify the factors associated with survival time with maintenance of KPS ≥ 50% (survival with KPS ≥ 50%) in patients with glioblastoma, IDH-wildtype. Ninety-eight patients with glioblastomas, IDH-wildtype, who were treated with concomitant radiotherapy (RT) and temozolomide (TMZ) followed by maintenance TMZ therapy, and whose KPS at the start of RT was ≥ 50%, were included. The median survival with KPS ≥ 50% was 13.3 months. In univariate analysis, preoperative KPS (≥ 80%), KPS at the start of RT (≥ 80%), residual tumor size (< 2 cm3), methylated MGMT promotor, and implantation of BCNU wafer were associated with survival with KPS ≥ 50%. In multivariate analysis, KPS at the start of RT (≥ 80%), methylated MGMT promotor, and residual tumor size (< 2 cm3) were significantly associated with increased survival with KPS ≥ 50%. A strategy of maximum possible tumor resection without compromising KPS is desirable to prolong the survival time with KPS ≥ 50%.

Keywords: Glioblastoma; Karnofsky Performance Status; MGMT; Radiotherapy; Temozolomide; Tumor size.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Fujita Health University (Approval No. HM22-434).

Figures

Fig. 1
Fig. 1
Patient selection flow chart. RT, radiotherapy, TMZ, temozolomide.
Fig. 2
Fig. 2
(a) Progression-free survival, (b) overall survival, and (c) survival time with maintenance of KPS ≥ 50%.
Fig. 3
Fig. 3
Survival time with maintenance of KPS ≥ 50% using the preoperative KPS cutoff value of (a) 90%, (b) 80%, and (c) 70%.
Fig. 4
Fig. 4
Survival time with maintenance of KPS ≥ 50% using KPS cutoff value at the start of RT of (a) 90%, (b) 80%, and (c) 70%.
Fig. 5
Fig. 5
(a) The survival time with maintenance of KPS ≥ 50% in patients with residual tumor size ≥ 2 cm3 versus < 2 cm3. (b) The survival time with maintenance of KPS ≥ 50% in patients with methylated MGMT promoter versus those with unmethylated MGMT promoter. (c) The survival time with maintenance of KPS ≥ 50% in patients treated with BCNU wafer versus those not treated with BCNU wafer. The median survival time with maintaining KPS ≥ 50 for each group is provided in Table 2.
Fig. 6
Fig. 6
The survival time with maintenance of KPS ≥ 50% in patients with none, one, two, or all three favorable factors (KPS at the start of RT ≥ 80%, methylated MGMT promotor, and residual tumor size < 2 cm3).
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