Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL, USA.
J Neurooncol. 2020 May;148(1):69-79. doi: 10.1007/s11060-020-03469-w. Epub 2020 May 3.
Glioblastoma multiforme (GBM) is a common and aggressive malignancy associated with poor prognosis. Characteristics and treatment of long-term survivors are of particular interest in efforts to improve outcomes. Therefore, the objective of this study was to examine trends and prognostic factors for 3-year survival from a national database.
The National Cancer Database (NCDB) was queried for patients diagnosed with cranial GBM from 2004 to 2013 and with 3-year follow-up. Trends in 3-year and overall survival, patient characteristics, tumor properties, and treatment modalities were examined. Multivariable logistic regression was utilized to investigate the association of these factors with 3-year survival. Predictor importance analysis was conducted using a metric defined as Wald χ penalized by degrees of freedom.
A total of 88,919 GBM patients with 3-year follow-up were identified. Overall, 8757 (9.8%) patients survived ≥ 3 years. Three-year survival significantly improved from 8.0 to 10.5% (p < 0.001) from 2004 to 2013. Trimodal treatment administration also significantly increased from 38.7 to 55.9% (p < 0.001). During this span, patients increasingly presented as older (p = 0.040), without private insurance (p < 0.001), and with a higher comorbidity index (p < 0.001). On multivariable regression, factors such as trimodal treatment (p < 0.001), younger age (p < 0.001), and MGMT methylation (p < 0.001) were significantly associated with increased odds of 3-year survival. Predictor importance analysis indicated that MGMT methylation, age, and treatment modality were the most significant relative determinants of 3-year survival.
These findings illustrate an improved 3-year survival rate for GBM patients from 2004 to 2013 with a concurrent increase in trimodal treatment administration despite more adverse patient presenting characteristics.
多形性胶质母细胞瘤（GBM）是一种常见且侵袭性强的恶性肿瘤，预后较差。在努力改善预后的过程中，长期生存者的特征和治疗方法尤其受到关注。因此，本研究的目的是从国家数据库中检查 3 年生存率的趋势和预后因素。
从 2004 年至 2013 年，国家癌症数据库（NCDB）对诊断为颅 GBM 并进行 3 年随访的患者进行了查询。检查了 3 年和总生存率、患者特征、肿瘤特征和治疗方式的趋势。利用多变量逻辑回归调查了这些因素与 3 年生存率的关系。使用由自由度加权的 Wald χ 定义的度量标准进行预测因子重要性分析。
共确定了 88919 例有 3 年随访的 GBM 患者。总体而言，有 8757 例（9.8%）患者存活≥3 年。从 2004 年至 2013 年，3 年生存率从 8.0%显著提高到 10.5%（p<0.001）。三模式治疗的实施也从 38.7%显著增加到 55.9%（p<0.001）。在此期间，患者的年龄越来越大（p=0.040），没有私人保险（p<0.001），合并症指数较高（p<0.001）。在多变量回归中，三模式治疗（p<0.001）、年龄较小（p<0.001）和 MGMT 甲基化（p<0.001）等因素与 3 年生存率的增加显著相关。预测因子重要性分析表明，MGMT 甲基化、年龄和治疗方式是 3 年生存率的最重要相对决定因素。
这些发现表明，从 2004 年至 2013 年，GBM 患者的 3 年生存率提高，尽管患者的表现特征更差，但同时三模式治疗的实施也有所增加。
