Putz Florian, Putz Tobias, Goerig Nicole, Knippen Stefan, Gryc Thomas, Eyüpoglu Ilker, Rössler Karl, Semrau Sabine, Lettmaier Sebastian, Fietkau Rainer
Department of Radiation Oncology, Friedrich-Alexander-University Erlangen-Nuremberg, Universitätsstraße 27, 91054, Erlangen, Germany.
Professorship of Demography, University of Bamberg, Feldkirchenstraße 21, 96052, Bamberg, Germany.
Strahlenther Onkol. 2016 Nov;192(11):797-805. doi: 10.1007/s00066-016-1046-0. Epub 2016 Sep 14.
Marital status is a well-described prognostic factor in patients with gliomas but the observed survival difference is unexplained in the available population-based studies.
A series of 57 elderly glioblastoma patients (≥70 years) were analyzed retrospectively. Patients received radiotherapy or chemoradiation with temozolomide. The prognostic significance of marital status was assessed. Disease complications, toxicity, and treatment delivery were evaluated in detail.
Overall survival was significantly higher in married than in unmarried patients (median, 7.9 vs. 4.0 months; p = 0.006). The prognostic significance of marital status was preserved in the multivariate analysis (HR, 0.41; p = 0.011). Married patients could receive significantly higher daily temozolomide doses (mean, 53.7 mg/m² vs. 33.1 mg/m²; p = 0.020), were more likely to receive maintenance temozolomide (45.7 % vs. 11.8 %; p = 0.016), and had to be hospitalized less frequently during radiotherapy (55.0 % vs. 88.2 %; p = 0.016). Of the patients receiving temozolomide, married patients showed significantly lower rates of hematologic and liver toxicity. Most complications were infectious or neurologic in nature. Complications of any grade were more frequent in unmarried patients (58.8 % vs. 30.0 %; p = 0.041) with the incidence of grade 3-5 complications being particularly elevated (47.1 % vs. 15.0 %; p = 0.004).
We found poorer treatment delivery as well as an unexpected severe increase in toxicity and disease complications in elderly unmarried glioblastoma patients. Marital status may be an important predictive factor for clinical decision-making and should be addressed in further studies.
婚姻状况是胶质瘤患者中一个描述详尽的预后因素，但在现有的基于人群的研究中，观察到的生存差异尚无合理解释。
回顾性分析了57例老年胶质母细胞瘤患者（≥70岁）。患者接受了放疗或替莫唑胺同步放化疗。评估了婚姻状况的预后意义。详细评估了疾病并发症、毒性和治疗实施情况。
已婚患者的总生存期显著高于未婚患者（中位数分别为7.9个月和4.0个月；p = 0.006）。多因素分析中婚姻状况的预后意义得以保留（HR，0.41；p = 0.011）。已婚患者能够接受显著更高剂量的每日替莫唑胺（平均剂量分别为53.7mg/m²和33.1mg/m²；p = 0.020），更有可能接受替莫唑胺维持治疗（45.7%对11.8%；p = 0.016），并且在放疗期间住院频率更低（55.0%对88.2%；p = 0.016）。在接受替莫唑胺治疗的患者中，已婚患者的血液学和肝脏毒性发生率显著更低。大多数并发症为感染性或神经性并发症。任何级别的并发症在未婚患者中更为常见（58.8%对30.0%；p = 0.041），3 - 5级并发症的发生率尤其升高（47.1%对15.0%；p = 0.004）。
我们发现老年未婚胶质母细胞瘤患者的治疗实施较差，并且毒性和疾病并发症意外地显著增加。婚姻状况可能是临床决策的一个重要预测因素，应在进一步研究中加以探讨。
