Patterns of Care in Elderly Glioblastoma Patients
Patterns of Care in Elderly Glioblastoma Patients
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DOI：
10.1002/ana.21521
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发表时间：
2008-12-01
影响因子：
11.2
通讯作者：
Abrey, Lauren E.
中科院分区：
文献类型：
--
作者：
Iwamoto, Fabio M.;Reiner, Anne S.;Abrey, Lauren E.
目的：从基于人群的大规模登记中评估老年胶质母细胞瘤(GBM)患者的护理模式。方法：我们从1994-2002年间与医疗保险索赔相关的监测、流行病学和最终结果癌症登记数据中确定了65岁或65岁以上的GBM患者队列。我们使用多因素Logistic回归分析人口统计学特征和合并症对诊断后3个月内接受手术切除、放疗和化疗的概率的影响。结果：共纳入4,137名GBM患者，中位总生存期为4个月。61%的患者在确诊时接受了切除术；65%的患者在确诊后3个月内接受了放疗，10%的患者接受了化疗。在多变量回归分析中，年龄是切除、放疗或化疗的最显著预测因素。黑人种族(优势比[OR]为0.64；p=0.008)与较低的手术切除率相关。与接受RT的可能性降低相关的因素包括未婚婚姻状况(OR，0.64；P<；0.0001)和更多的共病(OR，0.55；P<；0.0001)。接受化疗的可能性降低的相关因素包括未婚婚姻状况(OR，0.59；p=0.0002)和更多的合并症(OR，0.56；p=0.02)。在该队列中，年龄、婚姻状况和合并症影响接受RT或化疗的概率。
Objective: To evaluate the patterns of care in elderly glioblastoma (GBM) patients from a large population-based registry.Methods: We identified a cohort of GBM patients 65 years or older from Surveillance, Epidemiology, and End Results cancer registry data linked with Medicare claims between 1994 and 2002. We assessed the impact of demographic characteristics and comorbidities on the probability of undergoing surgical resection, radiotherapy (RT), and chemotherapy within 3 months of diagnosis using multivariate logistic regression.Results: A total of 4,137 patients with GBM were included, with a median overall survival of 4 months. Sixty-one percent of patients underwent resection at diagnosis; 65% received RT and 10% received chemotherapy within 3 months of diagnosis. In a multivariate regression analysis, age was the most significant predictor of resection, RT, or chemotherapy. Black race (odds ratio [OR], 0.64; p = 0.008) was associated with lower rates of surgical resection. Factors associated with decreased likelihood of receiving RT included unmarried marital status (OR, 0.64; p < 0.0001) and more comorbidities (OR, 0.55; p < 0.0001). Factors associated with decreased likelihood of receiving chemotherapy included unmarried marital status (OR, 0.59; p 0.0002) and more comorbidities (OR, 0.56; p = 0.02).Interpretation: Survival of elderly GBM patients was poor in this population-based study. Age, marital status, and comorbidities influenced the probability of receiving RT or chemotherapy in this cohort.