Department of Radiation Oncology, Cancer Center and Research Institute, Houston Methodist Hospital, Weill Cornell Medical College, Houston, TX, USA.
Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA.
J Neurooncol. 2018 Jan;136(2):307-315. doi: 10.1007/s11060-017-2654-y. Epub 2017 Oct 31.
This study evaluated practice patterns, outcomes, and predictors of survival with respect to the addition of chemotherapy to definitive hypofractionated radiation therapy (HFRT) for glioblastoma in a general patient population. The National Cancer Data Base was queried for patients diagnosed with glioblastoma between 2005 and 2012 that received definitive HFRT with or without chemotherapy. Patient, tumor, and treatment parameters were extracted. Statistics included Kaplan-Meier analysis to evaluate overall survival (OS) as well as Cox proportional hazards modeling to determine variables associated with receipt of chemotherapy and OS. Propensity score matching was performed in order to assess groups in a balanced manner while reducing indication biases. 693 patients met the inclusion criteria, of which 297 (42.9%) received HFRT alone, while 396 (57.1%) received chemotherapy and radiation therapy. Median follow-up was 5.2 months. Factors independently associated with chemotherapy delivery included age ≤ 65, methylated MGMT, and Asian race. Chemotherapy use was associated with improved median OS (6.8 vs. 4.3 months, p < 0.001). This persisted in both age groups of age ≤ 65 (8 vs. 4.4 months, p < 0.001) and > 65 years (6.1 vs. 4.3 months, p = 0.002) as well as on propensity-matched analysis (6.0 vs. 4.3 months, p < 0.001). In this patient population, novel independent predictors of OS were identified, which included the addition of chemotherapy (p < 0.001), receipt of surgery other than biopsy (both p < 0.05), and treatment at an academic institution (p = 0.002). Addition of chemotherapy to definitive HFRT was associated with improved OS in patients ≤ 65 and > 65 years of age. Chemotherapy was an independent predictor of OS, along with receipt of surgery and treatment at an academic institution.
这项研究评估了在一般患者人群中，对于接受立体定向放射治疗（HFRT）的胶质母细胞瘤患者，联合化疗与单纯接受 HFRT 的治疗方案、预后及生存率的关系。通过国家癌症数据库，检索了 2005 年至 2012 年间诊断为胶质母细胞瘤且接受单纯 HFRT 或 HFRT 联合化疗的患者。提取患者、肿瘤和治疗相关参数。统计学方法包括 Kaplan-Meier 分析以评估总生存期（OS）和 Cox 比例风险模型以确定与接受化疗和 OS 相关的变量。采用倾向评分匹配（propensity score matching，PSM）以平衡的方式评估两组，同时减少指示性偏倚。693 例患者符合纳入标准，其中 297 例（42.9%）接受单纯 HFRT，396 例（57.1%）接受化疗联合放疗。中位随访时间为 5.2 个月。与化疗相关的独立因素包括年龄≤65 岁、甲基化 MGMT 和亚洲种族。化疗组的中位 OS 明显延长（6.8 个月比 4.3 个月，p<0.001）。在年龄≤65 岁（8 个月比 4.4 个月，p<0.001）和>65 岁（6.1 个月比 4.3 个月，p=0.002）患者中，以及在倾向评分匹配分析中（6.0 个月比 4.3 个月，p<0.001），化疗均与 OS 延长有关。在该患者人群中，还确定了新的 OS 独立预测因素，包括化疗的加入（p<0.001）、接受手术（p<0.05）而非活检、以及在学术机构接受治疗（p=0.002）。对于≤65 岁和>65 岁的患者，HFRT 联合化疗可提高 OS。化疗是 OS 的独立预测因素，与手术和在学术机构治疗有关。
