Mukherjee Debraj, Sarmiento J Manuel, Nosova Kristin, Boakye Maxwell, Lad Shivanand P, Black Keith L, Nuño Miriam, Patil Chirag G
Center for Neurosurgical Outcomes Research, Maxine Dunitz Neurosurgical Institute, Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Suite A6600, Los Angeles, CA 90048, USA.
Department of Neurosurgery, University of Louisville, Louisville, KY, USA.
J Clin Neurosci. 2014 May;21(5):773-8. doi: 10.1016/j.jocn.2013.09.004. Epub 2013 Dec 16.
Postoperative radiotherapy (RT) is utilized routinely in the management of anaplastic World Health Organization Grade III gliomas (AG), including anaplastic astrocytoma (AA) and anaplastic oligodendroglioma (AO). However, the optimal role of RT in elderly AG patients remains controversial. We evaluated the effectiveness of RT in elderly AG patients using a national cancer registry. The USA Surveillance, Epidemiology, and End Results database (1990-2008) was used to query patients over 70 years of age with AA or AO. Independent predictors of overall survival were determined using a multivariate Cox proportional hazards model. Among 390 elderly patients with AG, 333 (85%) had AA and 57 (15%) had AO. Approximately two-thirds of AA patients (64%) and AO patients (65%) received RT. Most AO patients (58%) and many AA patients (41%) underwent surgical resection; the remainder had biopsy. The median overall survival for all patients who underwent RT was 6 months (95% confidence interval [CI], 5-7 months) versus 2 months (95% CI 1-6) in patients who did not have RT. Patients who had gross total resection (GTR) plus RT had a median overall survival of 11 months (95% CI 7-14). Multivariate analysis for all patients showed that undergoing RT was significantly associated with improved survival (hazard ratio [HR] 0.52, p<.0001). AA tumor type (HR 1.37, p=.03) was associated with worse survival than AO tumor type; female sex (HR 0.59, p<.0001) and being married (HR 0.66, p=.002) significantly improved survival. Patients that underwent GTR had a significant reduction in the hazards of mortality compared to biopsy (HR 0.72, p=.04). Elderly AG patients undergoing RT had better overall survival compared to patients who did not receive RT. Treatment strategies involving maximal safe resection plus RT should be considered in the optimal management of AG in elderly patients.
术后放疗（RT）通常用于间变性世界卫生组织III级胶质瘤（AG）的治疗，包括间变性星形细胞瘤（AA）和间变性少突胶质细胞瘤（AO）。然而，放疗在老年AG患者中的最佳作用仍存在争议。我们使用国家癌症登记处评估了放疗在老年AG患者中的有效性。美国监测、流行病学和最终结果数据库（1990 - 2008年）用于查询70岁以上患有AA或AO的患者。使用多变量Cox比例风险模型确定总生存的独立预测因素。在390例老年AG患者中，333例（85%）患有AA，57例（15%）患有AO。约三分之二的AA患者（64%）和AO患者（65%）接受了放疗。大多数AO患者（58%）和许多AA患者（41%）接受了手术切除；其余患者进行了活检。接受放疗的所有患者的中位总生存期为6个月（95%置信区间[CI]，5 - 7个月），而未接受放疗的患者为2个月（95%CI 1 - 6）。接受全切除（GTR）加放疗的患者中位总生存期为11个月（95%CI 7 - 14）。对所有患者的多变量分析表明，接受放疗与生存期改善显著相关（风险比[HR] 0.52，p <.0001）。AA肿瘤类型（HR 1.37，p =.03）与比AO肿瘤类型更差的生存期相关；女性（HR 0.59，p <.0001）和已婚（HR 0.66，p =.002）显著改善了生存期。与活检相比，接受GTR的患者死亡风险显著降低（HR 0.72，p =.04）。与未接受放疗的患者相比，接受放疗的老年AG患者总生存期更好。在老年患者AG的最佳管理中应考虑包括最大安全切除加放疗的治疗策略。
