Outcome of surgical treatment of malignant astrocytoma of the brain

The aim of this study was to analyze the outcome after the surgical treatment of patients with malignant brain astrocytomas, as well as the factors influencing the outcome. Retrospective study was performed on 145 operated patients (102 with glioblastoma multiforme, and 43 with anaplastic astrocytomas). Clinical state was graded according to the Yasargil scale (grades I-IV) and the Karnofski score, and the outcome was defined either as good (better or unchanged clinical state) or as poor (deteriorated state or death). The outcome was correlated with patients age and preoperative clinical condition, as well as with the localization, extensiveness and the extent of resection of the tumor. Preoperative clinical state of patients most frequently corresponded to grades II-III (75.9%). Radical resection was done in 48.3%, subtotal in 15.2%, partial in 30.3%, and biopsy was performed in 6.2% of patients, with the total operative mortality of 16.5%, morbidity of 9.7%, and good postoperative outcome in 73.8% of the patients. The incidence of good postoperative outcome did not significantly depend on the tumor location (42.6-78.3%), cortical presentation, the extent of resection (68.2-75.7%), and preoperative clinical state (67.8-81.5%). Good outcome was seen in 82.7% of patients with one, and in 53.8% of patients with three or more infiltrated lobes (p < 0.01). Patients with poor outcome were significantly older in average than the patients with good outcome (58.9 +/- 12.1 and 50.9 +/- 13.4 years of age, respectively; p < 0.05). Operative mortality was 7.4%, and 27.3% for clinical grades II and IV (p < 0.05), namely 11% and 23.8% for the patients with the Karnofski score above and under 50 (p < 0.05), respectively. The outcome after the operative treatment of malignant cerebral astrocytomas significantly depended on patients age and the extensity of the tumor. For such patients operative mortality was also significantly influenced by clinical preoperative state.