Survival Outcomes in Elderly Patients with Glioblastoma
Survival Outcomes in Elderly Patients with Glioblastoma
复制标题
DOI：
10.1016/j.clon.2014.11.026
复制
发表时间：
2015-03-01
影响因子：
3.4
通讯作者：
Tsao, M. N.
中科院分区：
文献类型：
--
作者：
Tsang, D. S.;Khan, L.;Tsao, M. N.
目的：许多老年胶质母细胞瘤患者由于年龄、合并症或功能状况不佳而被排除在随机试验之外。本研究的目的是描述在三级癌症中心治疗的所有老年胶质母细胞瘤患者的生存结果。材料和方法：回顾性分析了2006年12月1日至2013年12月31日期间组织学诊断为胶质母细胞瘤的235例老年患者（65岁或以上）。本研究的主要终点是按治疗类型划分的总生存期。使用单因素和多因素Cox比例风险模型来探索与总生存相关的重要预后变量。结果：所有患者的中位生存期为6.5个月（95%可信区间5.3-7.7），1年总生存期为23.7%（95%可信区间18.8-30.0）。放疗和化疗患者的中位生存期为11.1个月（95%可信区间为8.1-13.7）。单纯放疗患者的中位生存期为6.8个月（95%可信区间5.6-7.9）。对于仅采用舒适措施的患者，中位生存期为1.9个月（95%置信区间为1.6-2.6）。单因素分析显示，年龄、身体状况、手术类型（活检、次全切除、总全切除）和接受的治疗类型（仅采取舒适措施、单独放疗、放疗和化疗）与总生存率有统计学相关性。在多变量分析中，只有两个预测因素（接受的治疗和手术类型）具有显著性。结论：老年胶质母细胞瘤患者选择治疗（手术后单独放疗或放化疗）比采用舒适措施治疗的患者生存时间更长。前瞻性随机试验将有助于指导治疗患者的管理。被认为不适合积极治疗的老年胶质母细胞瘤患者的生存期很短。(C) 2014年英国皇家放射学院。Elsevier Ltd.出版。版权所有。
Aims: Many elderly glioblastoma patients are excluded from randomised trials due to age, comorbidity or poor functional status. The purpose of this study was to describe the survival outcomes in all elderly patients with glioblastoma managed at a tertiary cancer centre.Materials and methods: A retrospective chart review identified 235 elderly patients (age 65 years or over) with a histological diagnosis of glioblastoma between 1 December 2006 and 31 December 2013. The primary outcome of this study was overall survival by treatment type. Univariate and multivariate Cox proportional hazard models were used to explore significant prognostic variables associated with overall survival.Results: The median survival for all patients was 6.5 months (95% confidence interval 5.3-7.7), with 1 year overall survival of 23.7% (95% confidence interval 18.8-30.0). The median survival for patients treated with radiation and chemotherapy was 11.1 months (95% confidence interval 8.1-13.7). Patients treated with radiation alone had a median survival of 6.8 months (95% confidence interval 5.6-7.9). For patients managed with comfort measures only, the median survival was 1.9 months (95% confidence interval 1.6-2.6). Univariate analysis revealed age, performance status, surgery type (biopsy, subtotal resection, gross total resection) and type of treatment received (comfort measures only, radiotherapy alone, radiotherapy and chemotherapy) to be statistically associated with overall survival. In the multivariate analysis, only two predictive factors (treatment received and surgery type) were significant.Conclusions: Elderly patients with glioblastoma selected for treatment (surgery followed by radiation alone or radiation and chemotherapy) survive longer than patients managed with comfort measures. Prospective randomised trials will help guide management for patients eligible for therapy. Elderly patients with glioblastoma who are deemed not eligible for active therapy have very short survival. (C) 2014 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.