The Prognostic Value of NANO Scale Assessment in IDH-Wild-Type Glioblastoma Patients

Johannes Kasper; Tim Wende; Michael Karl Fehrenbach; Florian Wilhelmy; Katja Jähne; Clara Frydrychowicz; Gordian Prasse; Jürgen Meixensberger; Felix Arlt

doi:10.3389/fonc.2021.790458

The Prognostic Value of NANO Scale Assessment in IDH-Wild-Type Glioblastoma Patients

Front Oncol. 2021 Dec 2:11:790458. doi: 10.3389/fonc.2021.790458. eCollection 2021.

Authors

Johannes Kasper¹, Tim Wende¹, Michael Karl Fehrenbach¹, Florian Wilhelmy¹, Katja Jähne¹, Clara Frydrychowicz², Gordian Prasse³, Jürgen Meixensberger¹, Felix Arlt¹

Affiliations

¹ Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
² Division of Neuropathology, University Hospital Leipzig, Leipzig, Germany.
³ Institute of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.

Abstract

Background: IDH-wild-type glioblastoma (GBM) is the most frequent brain-derived malignancy. Despite intense research efforts, it is still associated with a very poor prognosis. Several parameters were identified as prognostic, including general physical performance. In neuro-oncology (NO), special emphasis is put on focal deficits and cognitive (dys-)function. The Neurologic Assessment in Neuro-Oncology (NANO) scale was proposed in order to standardize the assessment of neurological performance in NO. This study evaluated whether NANO scale assessment provides prognostic information in a standardized collective of GBM patients.

Methods: The records of all GBM patients treated between 2014 and 2019 at our facility were retrospectively screened. Inclusion criteria were age over 18 years, at least 3 months postoperative follow-up, and preoperative and postoperative cranial magnetic resonance imaging. The NANO scale was assessed pre- and postoperatively as well as at 3 months follow-up. Univariate and multivariate survival analyses were carried to investigate the prognostic value.

Results: One hundred and thirty-one patients were included. In univariate analysis, poor postoperative neurological performance (HR 1.13, p = 0.004), poor neurological performance at 3 months postsurgery (HR 1.37, p < 0.001), and neurological deterioration during follow-up (HR 1.38, p < 0.001), all assessed via the NANO scale, were associated with shorter survival. In multivariate analysis including other prognostic factors such as the extent of resection, adjuvant treatment regimen, or age, NANO scale assessment at 3 months postoperative follow-up was independently associated with survival prediction (HR 1.36, p < 0.001). The optimal NANO scale cutoff for patient stratification was 3.5 points.

Conclusion: Neurological performance assessment employing the NANO scale might provide prognostic information in patients suffering from GBM.

Keywords: GBM; NANO scale; glioblastoma; neuro-oncology; neurological performance.