Der prognostische Wert von frühen NANO-Score Änderungen für das Gesamtüberleben bei 330 WHO Grad 4 Gliom-Patienten: Eine große monozentrische Analyse

Resection is the cornerstone of glioma treatment, aiming for complete tumor removal while maintaining neurological function. Neurological deficits after surgery can gravely impact further treatment options. While ECOG scores are routinely used to evaluate treatment eligibility, we used the change in early postoperative NANO-score as predictor for overall survival (OS).

We retrospectively analyzed a cohort of glioma patients with WHO grade 4 glioma that underwent resective surgery between 2006 and 2023. In 330 patients, complete NANO scores could be evaluated pre- and postoperatively before discharge. Patients were stratified into three groups based on score changes: improvement/stable (no change or decrease), mild deterioration (1-2 point increase), or severe deterioration (≥3 points increase). OS was analyzed using Kaplan-Meier estimates and log-rank tests. A Cox Proportional Hazards model assessed the impact of NANO score changes while adjusting for MGMT methylation, extent of resection, and sex.

Patients with stable NANO scores (n=153) showed a mean OS of 67.6 weeks, comparable to mild deterioration (n=136, 57.6 weeks, p=0.36). Severe deterioration (n=41) resulted in significantly shorter OS (41.5 weeks) compared to stable (p =0.0013) and mild deterioration (p=0.0425). Multivariate analysis confirmed NANO score change as independent prognostic factor (HR = 1.21, p = 0.008).

Early postoperative change in NANO score demonstrates prognostic value for OS in grade 4 glioma patients. The lack of survival difference between stable and mild deterioration groups suggests that mild neurological deterioration may be prognostically less relevant than previously assumed. While the retrospective character of this study has limitations, these findings may foster the identification of subgroups that could benefit from more aggressive surgical concepts.