Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme Introduction Glioblastoma multiforme (GBM) is the most common primary intraaxial brain tumor in adults with an annual age adjusted incidence of 3.0–3.6 per 100,000 (1, 2). GBM is derived from the malignant transformation of either mature glial cells or neural stem cells (3, 4). The recommended treatment of GBM has after 2005 been tumor resection (as radical as possible) followed by radiotherapy (RT) with concomitant and adjuvant temozolomide (temozolomide che- moradiotherapy) (5). Before 2005, the documented effect of chemotherapy was only marginal (6), hence the primary treatment was in most cases surgery followed by RT alone (7–10). The benefi- cial role of cytoreductive surgery has in recent years been fairly well documented (11, 12). The median overall survival (OS) rate for GBM is in recent series reported to be 10.2–14.6 months (5, 9, 10, 13). Prognostic factors for OS are reported to be patient age, functional status, grade of resection, type of oncological treatment, and methylation status of the MGMT gene promotor (5, 7, 9–12, 14, 15). Nearly all patients with GBM will, within a 2-year period from time of primary surgery, experience tumor regrowth and eventually die of the tumor. The indications for, and efficacy of, repeated surgery at time of tumor recurrence are not well documented (16–19). Thus, Acta Neurol Scand 2010: 122: 159–167 DOI: 10.1111/j.1600-0404.2010.01350.x Copyright Ó 2010 The Authors Journal compilation Ó 2010 Blackwell Munksgaard ACTA NEUROLOGICA SCANDINAVICA Helseth R, Helseth E, Johannesen TB, Langberg CW, Lote K, Rønning P, Scheie D, Vik A, Meling TR. Overall survival, prognostic factors, and repeated surgery in a consecutive series of 516 patients with glioblastoma multiforme. Acta Neurol Scand: 2010: 122: 159–167. Ó 2010 The Authors Journal compilation Ó 2010 Blackwell Munksgaard. Objectives – To study overall survival (OS), prognostic factors, and repeated surgery in glioblastoma multiforme (GBM). Material and methods – Retrospective study of 516 consecutive adult patients who underwent primary surgery for a GBM in year 2003–2008. Results – Median age at primary surgery was 63.7 years (range 18.0–88.0). Median OS was 9.9 months. Age >60 years, poor preoperative ECOG score, bilateral tumor, biopsy rather than resection, and no temozolomide chemoradiotherapy were negative risk factors. Repeat surgery was performed in 65 patients (13%). Median time between first and second surgery was 7 months. Indications for second surgery were increasing neurological deficits (35.4%), raised ICP (33.8%), asymptomatic but reoperated because of tumor progression verified on MRI (20.0%), and epileptic seizures (11%). Patients who underwent repeated surgery had longer OS; 18.4 months vs 8.6 months (P < 0.001). Conclusions – OS for adult GBM patients was 9.9 months. Negative prognostic factors were increasing age, poor neurological function, bilateral tumor involvement, biopsy instead of resection, and RT alone compared to temozolomide chemoradiotherapy. Our rate of repeated surgery for GBM was 13% and the main indications for second surgery were raised ICP and increasing neurological deficits. In a carefully selected group of patients, repeat surgery significantly prolongs OS. R. Helseth 1 , E. Helseth 2,3 , T. B. Johannesen 4 , C. W. Langberg 5 , K. Lote 6 , P. Rønning 3 , D. Scheie 7 , A. Vik 1,8 , T. R. Meling 9 1 Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway; 2 Faculty of Medicine, University of Oslo, Oslo, Norway; 3 Department of Neurosurgery, Oslo University Hospital, Ullevål, Norway; 4 The Norwegian Cancer Registry, Oslo, Norway; 5 Department of Neurooncology, Oslo University Hospital, Ullevål, Norway; 6 Department of Neurooncology, Oslo University Hospital, Rikshospitalet, Norway; 7 Division of Pathology, Oslo University Hospital, Rikshospitalet, Norway; 8 Department of Neurosurgery, St. Olavs University Hospital, Trondheim, Norway; 9 Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, Norway Key words: glioblastoma; survival; primary treatment; repeated surgery; prognostic factors Torstein R. Meling, Department of Neurosurgery, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway Tel.: +47 23074843 Fax: +47 23074310 e-mail: torsteinrmeling@mailcity.com Accepted for publication February 4, 2010 159