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Neoplastic meningitis-related prognostic significance of the Karnofsky performance status
Marc C Chamberlain1, Sandra K Johnston, Mike J Glantz
1University of Washington, Department of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Center, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Mail Stop G-4940, Seattle, WA 98109-1023, USA. chambemc@u.washington.edu
Background:
The prognostic significance of Karnofsky performance status in neoplastic meningitis (NM) has not been demonstrated in patient groups similarly matched for known prognostic variables.
Objective:
To determine the effect of performance status on survival in NM.
Design:
Retrospective comparison.
Setting:
A university tertiary medical center.
Patients:
Two well-matched cohorts with cytologically positive NM with (n = 30; group A) and without (n = 30; group B) independence in activities of daily living as defined by a Karnofsky performance status score of 70 or greater or less than 70, respectively.
Main Outcome Measures:
Groups were matched on age, primary tumor, site of NM disease (cranial nerves or spinal cord), treatment (radiotherapy and chemotherapy; systemic and intraventricular), and absence of cerebrospinal fluid compartmentalization, NM-related encephalopathy, and neuroradiographic bulky central nervous system disease. Primary tumor histologic diagnoses included breast cancer (20 patients), non-Hodgkin lymphoma (10 patients), lung cancer (10 patients), melanoma (8 patients), and others (12 patients). At presentation, NM revealed cranial neuropathy (30 patients) or spinal cord dysfunction (39 patients). Radiotherapy was administered to 49 patients (whole brain only in 12 patients; restricted spine only in 35; whole brain and restricted spine in 2). All the patients received intraventricular chemotherapy, and 49 received concurrent tumor-specific systemic chemotherapy.
Results:
Median survival was 6 weeks (range, 3-10 weeks) in group B compared with 15.5 weeks (range, 8-58 weeks) in group A (P < .001). No treatment-related deaths were observed. All the patients demonstrated progressive disease and died of either NM or systemic cancer.
Conclusions:
A low Karnofsky performance status score predicts poor survival in patients with NM. Patients with a low Karnofsky performance status score may be best served by offering supportive care.
Insights
Karnofsky performance status significantly impacts survival in patients with neoplastic meningitis (NM). A lower score indicates poor prognosis, suggesting supportive care may be most beneficial for these individuals.
Area of Science:
- Oncology
- Neurology
- Clinical Medicine
Background:
- Prognostic significance of Karnofsky performance status (KPS) in neoplastic meningitis (NM) is not well-established in matched patient groups.
- Existing research lacks comprehensive matching for known prognostic variables.
Purpose of the Study:
- To determine the effect of performance status on survival in patients diagnosed with neoplastic meningitis.
- To evaluate Karnofsky performance status as a prognostic indicator in NM.
Main Methods:
- Retrospective comparison of two well-matched cohorts (n=30 each) of cytologically positive NM patients.
- Groups were stratified by Karnofsky performance status score (≥70 vs. <70), indicating independence in daily living activities.
- Matching criteria included age, primary tumor type, NM site, treatment modalities, and absence of specific complications like CSF compartmentalization or encephalopathy.
Main Results:
- Median survival was significantly longer in the higher KPS group (15.5 weeks) compared to the lower KPS group (6 weeks) (P < .001).
- No treatment-related deaths occurred.
- All patients experienced progressive disease, with mortality attributed to NM or systemic cancer.
Conclusions:
- A low Karnofsky performance status score is a significant predictor of poor survival in patients with neoplastic meningitis.
- For patients with a low KPS, focusing on supportive care is recommended.
