St Vincent's Hospital, Melbourne, VIC, Australia.
Centre for Palliative Care, Melbourne, VIC, Australia.
J Neurooncol. 2018 Jan;136(1):155-162. doi: 10.1007/s11060-017-2635-1. Epub 2017 Oct 27.
Glioblastoma has a poor prognosis with median survival of 12-14 months. Long-term survivors (LTS), alive at least 2 years from diagnosis, comprise 13% of this population. This study aims to provide a clinical profile of LTS at two institutions in Melbourne, Australia. Histological diagnosis of glioblastoma from 1st January 2006 to 31st December 2012 were identified from pathology/oncology databases. Demographic, treatment and survival characteristics were recorded (follow-up to 31st December 2015). Relevant inter-group statistics were used to identify differences between LTS and those surviving less than 2 years. Survival estimated by Kaplan-Meier. 776 patients were identified with 154 surviving > 2 years. Compared with patients surviving < 2 years, LTS were more likely to be younger (median age 56 vs. 65 years, p < .001), have ECOG 0-2 (97 vs. 65%, p < .001), gross tumour resection (91 vs. 61%, p < .001), and receive chemoradiotherapy (94 vs. 40%, p < .001). Most common presenting symptoms amongst LTS were headache (42%), seizure (28%) and speech disturbance (16%). Of LTS, 111 patients (72%) progressed at a median of 20.1 months from diagnosis, with 46% undergoing a second craniotomy. The most common non-surgical second line treatments were temozolomide (41%), followed by radiotherapy (12%). One-third of LTS received three or more lines of treatment, and 10% underwent three or more craniotomies. LTS of glioblastoma (20%) are more likely to be younger, have unilateral tumours, good performance status and undergo multimodality treatment. These data may assist in predicting LTS at diagnosis and understanding their clinical journey to facilitate planning of treatment and supportive care.
胶质母细胞瘤患者的中位生存期为 12-14 个月，预后较差。长期存活者（LTS）是指从诊断起至少存活 2 年的患者，占该人群的 13%。本研究旨在提供澳大利亚墨尔本两家机构的 LTS 临床特征。从病理/肿瘤学数据库中确定了 2006 年 1 月 1 日至 2012 年 12 月 31 日的胶质母细胞瘤的组织学诊断。记录了人口统计学、治疗和生存特征（随访至 2015 年 12 月 31 日）。使用相关的组间统计学方法来确定 LTS 与生存时间不足 2 年的患者之间的差异。使用 Kaplan-Meier 估计生存。共确定了 776 名患者，其中 154 名患者的生存时间超过 2 年。与生存时间不足 2 年的患者相比，LTS 更年轻（中位年龄 56 岁 vs. 65 岁，p<.001），ECOG 0-2（97% vs. 65%，p<.001）、大体肿瘤全切除（91% vs. 61%，p<.001）和接受放化疗（94% vs. 40%，p<.001）的可能性更大。LTS 最常见的首发症状为头痛（42%）、癫痫（28%）和言语障碍（16%）。在 LTS 中，111 名患者（72%）在诊断后中位时间 20.1 个月时进展，其中 46%接受了第二次开颅手术。最常见的二线非手术治疗是替莫唑胺（41%），其次是放疗（12%）。三分之一的 LTS 接受了三线或以上的治疗，10%的患者接受了三次或以上的开颅手术。胶质母细胞瘤的 LTS（20%）更年轻，有单侧肿瘤，功能状态良好，并接受多模式治疗。这些数据可能有助于在诊断时预测 LTS，并了解他们的临床治疗过程，以方便治疗和支持性护理的规划。
