McNamara Mairéad G, Lwin Zarnie, Jiang Haiyan, Chung Caroline, Millar Barbara-Ann, Sahgal Arjun, Laperriere Normand, Mason Warren P
Department of Medical Oncology, Pencer Brain Tumor Centre, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G 2M9, Canada.
J Neurooncol. 2014 Mar;117(1):153-60. doi: 10.1007/s11060-014-1368-7. Epub 2014 Jan 29.
With standard treatment for glioblastoma (GBM) consisting of surgery followed by radiotherapy (RT) with concurrent and adjuvant temozolomide (TMZ), median survival is ~14.6 months. This is not as informative to patients who have survived for some time. Conditional probability of survival may offer more relevant survival estimates. Outcomes/conditional probability of survival and post-progression survival (PPS) estimates were retrospectively reviewed in the TMZ treatment era of 882 consecutive patients with a diagnosis of GBM from January 2004 to August 2010. Median age of entire cohort was 62 years including 62 % males. Baseline performance status (PS) was 0-1 in 67, 23 % had frontal lobe tumors, 58 % received concurrent RT/TMZ ± adjuvant TMZ. Survival (OS) was similar for those with frontal lobe tumors versus other locations (P = 0.25). OS for patients receiving standard RT/TMZ ± TMZ was 14.2 months. Age, PS, extent of surgery, therapy post-surgery had significant effects on OS. OS for entire cohort at 1, 2, 3, 4, 5 years was 43.4, 17.9, 10.4, 8.4, 7.2 % respectively. Conditional probability of survival of an additional year given survival to 1, 2, 3, 4, 5 years was 41.4, 58, 80.7, 85.7, 81.5 % respectively. Conditional probability of survival for those patients receiving concurrent RT/TMZ ± adjuvant TMZ was similar. Patients who progress >18 months after their initial treatment for GBM had significantly greater 2 and 5 year PPS as well as OS. Conditional probabilities of survival may provide more meaningful life expectancy predictions for survivors of GBM than conventional survival outcomes.
胶质母细胞瘤（GBM）的标准治疗方案是手术，随后进行放疗（RT），同时和辅助使用替莫唑胺（TMZ），中位生存期约为14.6个月。这对于已经存活一段时间的患者来说信息不够充分。生存条件概率可能会提供更相关的生存估计。对2004年1月至2010年8月连续诊断为GBM的882例患者在TMZ治疗时代的生存结果/生存条件概率和进展后生存期（PPS）估计进行了回顾性分析。整个队列的中位年龄为62岁，其中62%为男性。67例患者的基线体能状态（PS）为0-1，23%患有额叶肿瘤，58%接受同步放化疗/替莫唑胺±辅助替莫唑胺治疗。额叶肿瘤患者与其他部位患者的总生存期（OS）相似（P = 0.25）。接受标准放化疗/替莫唑胺±替莫唑胺治疗的患者的总生存期为14.2个月。年龄、PS、手术范围、术后治疗对总生存期有显著影响。整个队列1、2、3、4、5年的总生存率分别为43.4%、17.9%、10.4%、8.4%、7.2%。在已存活1、2、3、4、5年的情况下，再存活一年的生存条件概率分别为41.4%、58%、80.7%、85.7%、81.5%。接受同步放化疗/替莫唑胺±辅助替莫唑胺治疗的患者的生存条件概率相似。在最初治疗GBM后进展超过18个月的患者，其2年和5年的PPS以及总生存期显著更长。与传统生存结果相比，生存条件概率可能为GBM幸存者提供更有意义的预期寿命预测。
