Department of Neurosurgery and INSERM U1051, Hôpital Saint Eloi-Gui de Chauliac, Centre Hospitalier Universitaire, 80 avenue Augustin Fliche, 34 295, Montpellier cedex 5, France.
Neurosurg Rev. 2014 Jul;37(3):415-23; discussion 423-4. doi: 10.1007/s10143-014-0528-8. Epub 2014 Feb 14.
The incidence of glioblastoma (GBM) has increased in patients aged 70 years or older, and will continue to grow. Elderly GBM patients have been excluded from most clinical trials; furthermore, optimal care management as well as benefit/risk ratio of GBM treatments are still being debated. This study describes oncological patterns of care, prognostic factors, and survival for patients ≥ 70 years in France. We identified patients over 70 with newly diagnosed and histologically confirmed GBM on data previously published by the French Brain Tumor DataBase. We included 265 patients. Neurological deficits and mental status disorders were the most frequent symptoms. The surgery consisted of resection (RS n = 95) or biopsy (B n = 170); 98 patients did not have subsequent oncological treatment. After surgery, first-line treatment consisted of radiotherapy (RT n = 76), chemotherapy (CT n = 52), and concomitant radiochemotherapy (CRC n = 39). The median age at diagnosis was 76, 74, and 73 years, respectively, for the untreated, B + RT and/or CT, RS ± RT and/or CT groups. Median survival (in days, 95 % CI) with these main strategies, when analyzed according to surgical groups, was: B-CT n = 41, 199[155-280]; B-CRC n = 21, 318[166-480]; B-RT n = 37, 149[130-214]; RS-CT n = 11, 245[211-na]; RS-CRC n = 18, 372[349-593]; RS-RT n = 39, 269[218-343]. This population study for elderly GBM patients is one of the most important in Europe, and could be considered as a historical cohort to compare future treatments. Moreover, we can hypothesize that elderly patients (versus patients <70 years) are undertreated. Karnofsky performance status seems to be the most relevant clinical predictive factor, and RS and CRC have a positive impact on survival for elderly GBM patients in the general population, at least when feasible.
胶质母细胞瘤（GBM）在 70 岁或以上的患者中的发病率有所增加，且这一趋势还将持续。大多数临床试验都将老年 GBM 患者排除在外；此外，GBM 治疗的最佳护理管理以及获益/风险比仍存在争议。本研究描述了法国 70 岁以上 GBM 患者的肿瘤治疗模式、预后因素和生存情况。我们在法国脑肿瘤数据库先前发表的数据中确定了新诊断为组织学确诊的 GBM 且年龄超过 70 岁的患者。我们共纳入了 265 名患者。神经功能缺损和精神状态障碍是最常见的症状。手术包括切除术（RS，n=95）或活检（B，n=170）；98 名患者未接受后续的肿瘤治疗。手术后，一线治疗包括放疗（RT，n=76）、化疗（CT，n=52）和同期放化疗（CRC，n=39）。未治疗、B+RT 和/或 CT、RS+/-RT 和/或 CT 组患者的中位诊断年龄分别为 76、74 和 73 岁。根据手术组分析，采用这些主要治疗策略的中位生存时间（天数，95%CI）为：B-CT 组 n=41，199[155-280]；B-CRC 组 n=21，318[166-480]；B-RT 组 n=37，149[130-214]；RS-CT 组 n=11，245[211-na]；RS-CRC 组 n=18，372[349-593]；RS-RT 组 n=39，269[218-343]。这项针对老年 GBM 患者的大型研究是欧洲最重要的研究之一，可作为未来治疗的比较依据。此外，我们可以假设，老年患者（与<70 岁患者相比）治疗不足。卡氏功能状态评分似乎是最相关的临床预测因素，RS 和 CRC 对一般人群中老年 GBM 患者的生存有积极影响，至少在可行的情况下是这样。
