Prognostic significance of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma: a comparison across six peri-treatment assessments.
Tokiwa S, Natsume K, et al. • Journal of neuro-oncology • 2026
Discharge FAC carries prognostic information not captured by contemporaneous global performance status and is a practical bedside marker at the transition to post-discharge care, rather than a stand-alone prediction tool.
Key Findings
Results
Higher Functional Ambulation Category (FAC) scores were associated with longer overall survival at all six peri-treatment time points in newly diagnosed glioblastoma patients.
FAC was assessed at six time points: preoperatively, on postoperative day 5, before chemoradiotherapy, at discharge, and 1 and 4 months after discharge.
The strongest univariable association between FAC and overall survival was observed at the discharge time point.
The study included 185 adults with newly diagnosed GBM treated from 2011 to 2020 at a single center.
This was a retrospective study design.
Results
Discharge FAC was independently associated with overall survival after adjustment for age, sex, extent of resection, and discharge Karnofsky Performance Status (KPS).
The discharge-landmark model included n=162 patients with 138 deaths.
Adjusted hazard ratio versus FAC 0-1 was 0.45 (95% CI, 0.27-0.73) for FAC 2-4.
Adjusted hazard ratio versus FAC 0-1 was 0.33 (95% CI, 0.17-0.63) for FAC 5.
FAC was grouped into three categories: 0-1, 2-4, and 5 for the primary analysis.
Results
Adding discharge FAC to a model already containing KPS and other covariates improved model fit and discriminative ability.
Change in Akaike information criterion (ΔAIC) was -8.4, indicating improved model fit.
Change in Harrell's C-index was +0.022 with addition of FAC.
The improvement in discrimination reached statistical significance at p=0.002.
Incremental performance was assessed using both AIC and Harrell's C-index.
Results
The prognostic estimates for discharge FAC were unchanged after additional adjustment for bevacizumab use and post-discharge temozolomide.
Sensitivity analyses included adjustment for bevacizumab and post-discharge temozolomide treatment.
The independence of FAC's prognostic value from these treatment variables suggests it is not merely a proxy for treatment received.
The primary model adjusted for age, sex, extent of resection, and discharge KPS.
Results
The Functional Ambulation Category at hospital discharge provides prognostic information beyond what is captured by contemporaneous global performance status (KPS) in glioblastoma.
KPS is the standard global performance status measure used in neuro-oncology practice.
FAC is a walking-specific functional measure readily assessed at the bedside.
The authors characterize discharge FAC as 'a practical bedside marker at the transition to post-discharge care, rather than a stand-alone prediction tool.'
This finding suggests walking ability captures a dimension of functional status not fully reflected by global performance status scores.
What This Means
This research suggests that measuring a brain tumor patient's walking ability when they leave the hospital can help predict how long they will survive, and that this information is meaningful even after accounting for other established prognostic factors. The study followed 185 patients with glioblastoma—the most aggressive common brain tumor—and measured their walking ability at six different time points using a standardized scale called the Functional Ambulation Category (FAC), which ranges from no walking ability to fully independent walking. Patients who could walk better at hospital discharge survived longer on average, and this relationship held up even after statistically controlling for age, sex, how much of the tumor was removed, overall physical condition scores (Karnofsky Performance Status), and the treatments patients received afterward.
A key finding is that walking ability at discharge added meaningful prognostic information beyond the standard performance status score that doctors already use. In statistical terms, adding the walking score improved how well the model could distinguish between patients with better or worse outcomes (C-index improved by 0.022, p=0.002). Patients who could walk independently had roughly one-third the risk of death compared to those who could not walk or could only walk with physical assistance, after adjusting for other factors.
This research suggests that a simple bedside walking assessment—which requires no special equipment—could be a useful additional tool for clinicians and families discussing prognosis at the time of hospital discharge for glioblastoma patients. The authors are careful to note that FAC should be viewed as one piece of information to complement existing tools rather than a stand-alone predictor, and that as a retrospective single-center study, these findings would benefit from confirmation in future prospective research.
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Tokiwa S, Natsume K, Yoshida A, Yonezawa H, Kawamura K, Nakanishi K, et al.. (2026). Prognostic significance of walking ability at hospital discharge for overall survival in newly diagnosed glioblastoma: a comparison across six peri-treatment assessments.. Journal of neuro-oncology. https://doi.org/10.1007/s11060-026-05784-0