10040-CS-6 Retrospective analysis of prognostic factors in WHO Grade 4 gliomas treated at a single institute

Abstract Purpose In this retrospective study, we investigated overall survival (OS) and its association with various clinical factors in patients with WHO grade 4 gliomas treated after the introduction of temozolomide. Methods We retrospectively reviewed the clinical records of consecutive patients who were newly diagnosed with WHO grade 4 glioma and treated at our institute between July 1, 2006 and December 31, 2022. Data on treatment and clinical course were extracted from medical records and analyzed in relation to overall survival (OS). Results A total of 119 patients were included in the analysis. The median OS for the entire cohort was 586 days (approximately 19 months), consistent with previous randomized controlled trials. Patients with a preoperative Karnofsky Performance Status (KPS) 70 or more (n = 50) had a significantly longer median OS (836 days) compared to those with KPS 60 or less (n = 69, median OS: 450 days ; p < 0.05, log-rank test). Use of 5-aminolevulinic acid (5-ALA) during surgery (n = 61) was associated with a significantly longer median OS (1013 days) compared to non-use (n = 53,374 days). Patients who underwent subtotal or greater resection at initial surgery (n = 54) had a significantly longer median OS (1285 days) than those who had partial resection or biopsy (n = 63,441 days). Female patients (n = 59) had a significantly longer median OS (733 days) compared to male patients (n = 60,479 days). In multivariate Cox proportional hazards analysis, preoperative KPS, extent of resection, and sex were independently associated with OS. Conclusion Although this retrospective study is subject to inherent biases, our findings suggest that higher preoperative KPS, greater extent of resection at initial treatment, and female sex are associated with prolonged survival in patients with WHO grade 4 glioma.