Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
PLoS One. 2020 Feb 13;15(2):e0228480. doi: 10.1371/journal.pone.0228480. eCollection 2020.
Elderly patients with glioblastoma and an accumulation of negative prognostic factors have an extremely short survival. There is no consensus on the clinical management of these patients and many may escape histologically verified diagnosis. The primary aim of this study was to characterize this particular subgroup of patients with radiological glioblastoma diagnosis without histological verification. The secondary aim was to evaluate if oncological therapy was of benefit.
Between November 2012 and June 2016, all consecutive patients presenting with a suspected glioblastoma in the western region of Sweden were registered in a population-based study. Of the 378 patients, 131 (35%) met the inclusion criteria of the present study by typical radiological features of glioblastoma without histological verification.
The clinical characteristics of the 131 patients (72 men, 59 women) were: age ≥ 75 (n = 99, 76%), performance status according to Eastern Cooperative Oncology Group ≥ 2 (n = 93, 71%), significant comorbidity (n = 65, 50%) and multilobular tumors (n = 90, 69%). The overall median survival rate was 3.6 months. A subgroup of 44 patients (34%) received upfront treatment with temozolomide, with an overall radiological response rate of 34% and a median survival of 6.8 months, compared to 2.7 months for those receiving best supportive care only. Good performance status and temozolomide treatment were statistically significant favorable prognostic factors, while younger age was not.
Thirty-five percent of patients with a radiological diagnosis of glioblastoma in our region lacked histological diagnosis. Apart from high age and poor performance status, they had more severe comorbidities and extensive tumor spread. Even for this poor prognostic group upfront treatment with temozolomide was shown of benefit in a subgroup of patients. Our data illustrate the need of non-invasive diagnostic methods to guide optimal individualized therapy for patients considered too fragile for neurosurgical biopsy.
患有胶质母细胞瘤且存在大量预后不良因素的老年患者的生存期极短。对于这些患者的临床治疗尚无共识，且许多患者可能逃避了组织学确诊。本研究的主要目的是描述影像学诊断为胶质母细胞瘤但未经组织学确诊的这一特定亚组患者的特征。次要目的是评估肿瘤治疗是否有益。
在 2012 年 11 月至 2016 年 6 月期间，瑞典西部的所有连续出现疑似胶质母细胞瘤的患者均在一项基于人群的研究中进行了登记。在 378 名患者中，有 131 名（35%）符合本研究的纳入标准，其影像学特征典型，为未经组织学确诊的胶质母细胞瘤。
131 名患者（72 名男性，59 名女性）的临床特征为：年龄≥75 岁（n=99，76%）、东部肿瘤协作组表现状态≥2（n=93，71%）、显著合并症（n=65，50%）和多叶肿瘤（n=90，69%）。总体中位生存期为 3.6 个月。44 名患者（34%）接受了替莫唑胺的一线治疗，总体影像学缓解率为 34%，中位生存期为 6.8 个月，而仅接受最佳支持治疗的患者中位生存期为 2.7 个月。良好的表现状态和替莫唑胺治疗是统计学上的有利预后因素，而年龄较小则不是。
在我们的地区，影像学诊断为胶质母细胞瘤的患者中有 35%缺乏组织学诊断。除了高龄和表现状态不佳外，他们还具有更严重的合并症和广泛的肿瘤扩散。即使对于这一预后较差的亚组，替莫唑胺的一线治疗也显示出了益处。我们的数据表明，需要非侵入性诊断方法来指导对认为太脆弱而无法进行神经外科活检的患者进行最佳个体化治疗。
