Comparative Analysis of Survival Outcomes and Prognostic Factors of Supratentorial versus Cerebellar Glioblastoma in the Elderly: Does Location Really Matter?
Comparative Analysis of Survival Outcomes and Prognostic Factors of Supratentorial versus Cerebellar Glioblastoma in the Elderly: Does Location Really Matter?
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DOI：
10.1016/j.wneu.2020.11.003
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发表时间：
2021-02-16
影响因子：
2
通讯作者：
Esquenazi, Yoshua
中科院分区：
文献类型：
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作者：
Chandra, Ankush;Lopez-Rivera, Victor;Esquenazi, Yoshua
背景：小脑胶质母细胞瘤（cGBM）是罕见肿瘤，在老年人中并不常见。在本研究中，我们比较了老年 cGBM 与幕上 (stGBM) 的生存结果并确定了预后因素。方法：使用 SEER 18 登记处的数据来识别 2000 年至 2016 年间诊断为胶质母细胞瘤 (GBM) 的患者。使用对数秩方法和多变量 Cox 比例风险回归模型进行分析。结果：在 110 名患有胶质母细胞瘤的老年患者中， cGBM，中位年龄为 74 岁（四分位距 [IQR]，69-79 岁），39% 为女性，83% 为白人。在这些患者中，32% 接受了全切除，73% 接受了放疗，39% 接受了化疗。对未匹配和匹配队列的多变量分析表明，肿瘤位置与生存无关；在未匹配的队列中，保险状况（风险比[HR]，0.11；IQR，0.02-0.49；P = 0.004）、总切除（HR，0.53；IQR，0.30-0.91；P = 0.022）和放疗（HR，0.33；IQR，0.18-0.61；P < 0.0001）与更好的生存相关。接受放疗（7 个月与 2 个月；P < 0.001）和化疗（10 个月与 3 个月；P < 0.0001）的 cGBM 和 stGBM 患者的生存率有所提高。与 stGBM 队列相比，老年人 cGBM 患者 24 个月时的长期死亡率较低 (P = 0.007)。结论：在我们的研究中，cGBM 和 stGBM 老年患者的总生存率相似，而接受最大切除并辅助治疗的患者（无论肿瘤位置如何）的预后均有所改善。因此，应鼓励老年患者对 cGBM 进行积极治疗，以获得与 stGBM 相同的生存获益。有必要进行单机构和多机构研究来确定患者层面的预后因素，以筛选出最佳的手术候选者。
BACKGROUND: Cerebellar glioblastomas (cGBMs) are rare tumors that are uncommon in the elderly. In this study, we compare survival outcomes and identify prognostic factors of cGBM compared with the supratentorial (stGBM) counterpart in the elderly.METHODS: Data from the SEER 18 registries were used to identify patients with a glioblastoma (GBM) diagnosis between 2000 and 2016. The log-rank method and a multi-variable Cox proportional hazards regression model were used for analysis.RESULTS: Among 110 elderly patients with cGBM, the median age was 74 years (interquartile range [IQR], 69-79 years), 39% were female and 83% were white. Of these patients, 32% underwent gross total resection, 73% radio-therapy, and 39% chemotherapy. Multivariable analysis of the unmatched and matched cohort showed that tumor location was not associated with survival; in the unmatched cohort, insurance status (hazard ratio [HR], 0.11; IQR, 0.02-0.49; P = 0.004), gross total resection (HR, 0.53; IQR, 0.30-0.91; P = 0.022), and radiotherapy (HR, 0.33; IQR, 0.18-0.61; P < 0.0001) were associated with better survival. Patients with cGBM and stGBM undergoing radiotherapy (7 months vs. 2 months; P < 0.001) and chemotherapy (10 months vs. 3 months; P < 0.0001) had improved survival. Long-term mortality was lower for cGBM in the elderly at 24 months compared with the stGBM cohort (P = 0.007).CONCLUSIONS: In our study, elderly patients with cGBM and stGBM have similar outcomes in overall survival, and those undergoing maximal resection with adjuvant therapies, independent of tumor location, have improved outcomes. Thus, aggressive treatment should be encouraged for cGBM in geriatric patients to confer the same survival benefits seen in stGBM. Single-institutional and multi-institutional studies to identify patient-level prognostic factors are warranted to triage the best surgical candidates.