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Cent Eur Neurosurg 2008; 69(2): 65-70
DOI: 10.1055/s-2007-1004579
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

A New Scoring System for Malignant Astrocytomas

Neues Scoringsystem für maligne AstrozytomeZ. Kojadinovic 1 , V. Papic 1 , T. Cigic 1 , P. Vulekovic 1 , Lj. Popovic 1 , Dj. Jajic 1
  • Clinic of Neurosurgery, University Clinical Center Novi Sad, Novi Sad, Serbia and Montenegro
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Publication History

Publication Date:
29 April 2008 (online)

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Abstract

Background: Currently there are a few scoring systems for malignant astrocytoma, but they are not widely accepted. The aim of this study was to create a scoring system for supratentorial malignant astrocytoma, which could be used in both developed and developing societies.

Methods: This study was performed in 128 patients who had supratentorial malignant astrocytoma (grade III or IV). They were operated, and after the operation patients were irradiated with 50-60 Gy.

Findings: The mean age was 55.1 years. The mean Karnofsky performance status (KPS) was 51. The tumour removal >90% was achieved in 57.8%. A biopsy was never exclusively performed. The mean survival was 8.2 months and 12-month survival was 25%. Thirteen out of 35 data that we tested had a prognostic value for survival time. By using the most appropriate four parameters (age, KPS, initial seizure and histopathological grade) we created a scoring system - MAS (Malignant Astrocytoma Score). The scores range from 0-16. The area under the ROC (Receiver Operating Characteristic) curve showed that the AUC for the prediction of 6-, 12- and 18-month survival was 0.729, 0.755, and 0.927. We compared MAS with two of the most commonly used scoring systems. The AUC for the same prediction, using the MRC (Medical Research Council) was 0.673, 0.637, and 0.888. For the RTOG (Radiation Therapy Oncology Group) score the AUC was 0.672, 0.700, and 0.854.

Conclusions: We are of the opinion that MAS represents a useful scoring system to determine the severity of the illness and make a prognosis for both individuals and groups of patients with malignant supratentorial astrocytoma. MAS is more accurate than predictions made by other systems currently in use; it includes prognostic factors that are widely accepted; it can be done at the patient's bedside and in clinics in developing societies.

Zusammenfassung

Einleitung: Zurzeit existieren einige Scoringsysteme für maligne Astrozytome, die jedoch keine breite Akzeptanz gefunden haben. Die Zielsetzung dieser Arbeit lag darin, ein Scoringsystem für supratentorielle maligne Astrozytome zu entwickeln, welches sowohl in den entwickelten Staaten, als auch in den Entwicklungsländern zur Anwendung kommen könnte.

Methoden: Die Untersuchung wurde bei insgesamt 128 Patienten durchgeführt, die an supratentoriellen malignen Astrozytomen (III. und IV. Grades) erkrankt waren. Sie alle wurden operiert, wonach eine Strahlentherapie mit einer Dosis von 50-60 Gy erfolgte.

Ergebnisse: Die Patienten waren im Durchschnitt 55,1 Jahre alt. Der durchschnittliche Karnofsky-Index betrug 51. Mehr als 90% der Tumormasse wurden bei 57,8% der Erkrankten entfernt. In keinem der Fälle wurde lediglich eine Biopsie vorgenommen. Die durchschnittliche Überlebensdauer lag bei 8,2 Monaten, während eine Überlebensdauer von 12 Monaten bei 25% der Patienten verzeichnet wurde. Dreizehn von den insgesamt 35 untersuchten Faktoren besaßen einen prognostischen Effekt auf die Überlebensdauer. Indem wir die 4 besten Parameter (Alter, Karnofsky-Index, initiale Epilepsie und histopathologischer Grad) nutzten, haben wir das Scoringsystem - MAS (maligner Astrozytomen Score) entwickelt. Der Score kann einen Wert von 0-16 haben. Die Fläche unter der ROC-Kurve (AUC) hatte für die Vorhersage der Lebensdauer von 6, 12 und 18 Monaten folgende Werte: 0.729, 0.755, 0.927. Wir haben den MAS mit den zwei am meisten zitierten Scoringsysteme verglichen. Für die gleiche Vorhersage mittels des MRC (Medical Research Council) lagen die AUC-Werte bei 0.673, 0.637, 0.888. Die Vorhersage mittels der RTOG (Radiation Therapy Oncology Group) ergab die AUC-Werte 0.672, 0.700, 0.854.

Schlussfolgerungen: Wir sind der Meinung, dass der MAS ein nützliches Scoringsystem für die Bestimmung der Schwere und der Prognose der Krankheit bei einzelnen und Gruppen von Patienten darstellt, die an supratentoriellen malignen Astrozytomen erkrankt sind. Der MAS besitzt folgende Charakteristiken: er ist präziser als die gängigen Prognostizierungsmethoden; er schließt Prognostizierungsfaktoren mit ein, die breite Anerkennung gefunden haben; er kann am Bett des Patienten und in den Entwicklungsländern angewendet werden.

Key words

malignant glioma - astrocytoma - glioblastoma - outcome assessment - prognostic score - prognosis

Schlüsselwörter

malignes Gliom - Astrozytom - Glioblastom - Ergebnisbewertung - Prognosevorhersage - Prognose

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Correspondence

Dr. Z. Kojadinovic

Clinic of Neurosurgery

University Clinical Center Novi Sad

Hajduk Veljkova 7

Novi Sad

21000 Serbia and Montenegro

Phone: +381/21/474 04 68

Fax: +381/21/521 74 5

Email: koja@eunet.yu