Glioblastoma in the Elderly The Memorial Sloan-Kettering Cancer Center Experience (1997-2007)
Glioblastoma in the Elderly The Memorial Sloan-Kettering Cancer Center Experience (1997-2007)
复制标题
DOI：
10.1002/cncr.24413
复制
发表时间：
2009-08-15
期刊：
影响因子：
6.2
通讯作者：
Abrey, Lauren E.
中科院分区：
文献类型：
--
作者：
Iwamoto, Fabio M.;Cooper, Anna R.;Abrey, Lauren E.
背景：胶质母细胞瘤（GBM）是最常见的恶性原发性脑肿瘤，约50%的病例发生在≥ 65岁的患者中。然而，据作者所知，老年GBM患者尚无公认的标准治疗，迄今为止尚未对老年GBM人群的特定预后因素进行系统研究。方法：使用纪念斯隆-凯特琳癌症中心机构数据库识别诊断时年龄≥ 65岁的组织学确诊GBM患者。结果：纳入了394例GBM患者，中位年龄为71.9岁（其中59%为男性）。大约18%的患者接受了活检，而82%的患者接受了肿瘤切除术; 81%的患者接受了放疗（RT），43%的患者接受了辅助化疗。中位总生存期为8.6个月;末次随访时，90%的患者死亡，39例存活患者的中位随访时间为12个月。在多变量分析中，年龄小，更好的Karnofsky性能状态（KIDS），单一肿瘤，手术切除被认为是生存的独立预测因素。将103例接受辅助化疗的患者与48例仅接受RT后随访的患者进行比较，在调整年龄、KPS、手术切除范围和病变数量后，死亡风险降低了55%（风险比，0.45; 95%置信区间，0.30-0.66 [P < .0001]）。结论：与年轻GBM患者的研究相似，年龄增长、KIDS和肿瘤切除程度在本研究中被发现是独立的预后因素。虽然老年GBM患者的生存率较低，但年龄本身不应使患者失去手术切除、RT和化疗等积极治疗的资格。Cancer 2009;115：3758-66. (C)2009年美国癌症协会。
BACKGROUND: Glioblastoma (GBM) is the most common malignant primary brain tumor, and approximately 50% of cases occur in patients aged >= 65 years. However, to the authors' knowledge, there is no accepted standard treatment for elderly GBM patients, and specific prognostic factors in the elderly GBM population have not been systematically studied to date. METHODS: The Memorial Sloan-Kettering Cancer Center institutional database was used to identify patients with histologically confirmed GBM who were aged >= 65 years at the time of diagnosis. RESULTS: Three hundred ninety-four GBM patients with a median age of 71.9 years (59% of whom were men) were included. Approximately 18% of patients underwent biopsy, whereas 82% underwent tumor resection; 81% received radiotherapy (RT), and 43% received adjuvant chemotherapy. The median overall survival was 8.6 months; at the time of last follow-up, 90% of patients had died, and the median follow-up of the 39 surviving patients was 12 months. In a multivariate analysis, younger age, better Karnofsky performance status (KIDS), single tumor, and surgical resection were found to be independent predictors of survival. Comparing 103 patients who received adjuvant chemotherapy with 48 who were only followed after RT, there was a 55% decrease in the risk of death (hazards ratio, 0.45; 95% confidence interval, 0.30-0.66 [P < .0001]) after adjusting for age, KPS, extent of surgical resection, and number of lesions. CONCLUSIONS: Similar to studies in younger GBM patients, advancing age, KIDS, and extent of tumor resection were found to be independent prognostic factors in the current study. Although survival is inferior in older GBM patients, age alone should not disqualify patients from aggressive therapy with surgical resection, RT, and chemotherapy. Cancer 2009;115:3758-66. (C) 2009 American Cancer Society.