Department of Neurological Surgery, University of California, San Francisco, California.
Departments of Neurological Surgery and Epidemiology and Biostatistics, University of California, San Francisco, California.
Neurosurgery. 2018 Jan 1;82(1):64-75. doi: 10.1093/neuros/nyx148.
Elderly patients with glioblastoma have an especially poor prognosis; optimizing their medical and surgical care remains of paramount importance.
To investigate patient and treatment characteristics of elderly vs nonelderly patients and develop an algorithm to predict elderly patients' survival.
Retrospective analysis of 554 patients (mean age = 60.8; 42.0% female) undergoing first glioblastoma resection or biopsy at our institution (2005-2011).
Of the 554 patients, 218 (39%) were elderly (≥65 yr). Compared with nonelderly, elderly patients were more likely to receive biopsy only (26% vs 16%), have ≥1 medical comorbidity (40% vs 20%), and develop postresection morbidity (eg, seizure, delirium; 25% vs 14%), and were less likely to receive temozolomide (TMZ) (78% vs 90%) and gross total resection (31% vs 45%). To predict benefit of resection in elderly patients (n = 161), we identified 5 factors known in the preoperative period that predicted survival in a multivariate analysis. We then assigned points to each (1 point: Charlson comorbidity score >0, subtotal resection, tumor >3 cm; 2 points: preoperative weakness, Charlson comorbidity score >1, tumor >5 cm, age >75 yr; 4 points: age >85 yr). Having 3 to 5 points (n = 78, 56%) was associated with decreased survival compared to 0 to 2 points (n = 41, 29%, 8.5 vs 16.9 mo; P = .001) and increased survival compared to 6 to 9 points (n = 20, 14%, 8.5 vs 4.5 mo; P < .001). Patients with 6 to 9 points did not survive significantly longer than elderly patients receiving biopsy only (n = 57, 4.5 vs 2.7 mo; P = .58).
Further optimization of the medical and surgical care of elderly glioblastoma patients may be achieved by providing more beneficial therapies while avoiding unnecessary resection in those not likely to receive benefit from this intervention.
老年胶质母细胞瘤患者预后极差；优化他们的医疗和手术护理仍然至关重要。
研究老年患者与非老年患者的患者和治疗特征，并制定一种预测老年患者生存的算法。
对我院 2005 年至 2011 年间接受首次胶质母细胞瘤切除术或活检的 554 例患者（平均年龄=60.8 岁，42.0%为女性）进行回顾性分析。
在 554 例患者中，218 例（39%）为老年（≥65 岁）患者。与非老年患者相比，老年患者更可能仅接受活检（26%比 16%），合并≥1 种医学合并症（40%比 20%），术后发病率（如癫痫发作、意识障碍；25%比 14%）更高，且更不可能接受替莫唑胺（TMZ）（78%比 90%）和大体全切除（31%比 45%）。为了预测老年患者（n=161）手术的获益，我们在多变量分析中确定了 5 个术前已知的因素，这些因素可以预测生存。然后，我们为每个因素分配 1 分（1 分：Charlson 合并症评分>0、次全切除、肿瘤>3 cm；2 分：术前虚弱、Charlson 合并症评分>1、肿瘤>5 cm、年龄>75 岁；4 分：年龄>85 岁）。与 0 分到 2 分（n=41，29%，8.5 比 16.9 个月；P=0.001）相比，有 3 到 5 分（n=78，56%）与降低的生存率相关，与 6 到 9 分（n=20，14%，8.5 比 4.5 个月；P<.001）相比则与生存率升高相关。与仅接受活检的老年患者（n=57，4.5 比 2.7 个月；P=0.58）相比，6 到 9 分的患者并未显著延长生存时间。
通过为那些不太可能从手术干预中获益的患者提供更有益的治疗方法，同时避免不必要的手术，可能会进一步优化老年胶质母细胞瘤患者的医疗和手术护理。
