Lu Victor M, Lewis Cole T, Esquenazi Yoshua
Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
Neurooncol Pract. 2020 Jun 3;7(5):522-530. doi: 10.1093/nop/npaa029. eCollection 2020 Oct.
Treatment for glioblastoma (GBM) in elderly (age > 65 years) patients can be affected by multiple geographic and socioeconomic parameters. Correspondingly, the aim of this study was to determine trends in treatment of elderly GBM patients in the United States.
All GBM patients in the U.S. National Cancer Database between 2005 and 2016 were retrospectively reviewed. Status of treatment by triple therapy (resection, chemotherapy, and radiation) were summarized and analyzed by U.S. Census region.
There were 44 338 GBM patients included, with 21 573 (49%) elderly and 22 765 (51%) nonelderly patients with median ages 72 years (range, 65-90 years) and 47 years (range, 40-64 years), respectively. Compared to nonelderly patients, elderly patients had significantly lower odds of being treated by triple therapy (odds ratio, OR = 0.54) as a whole, and its individual elements of resection (OR = 0.78), chemotherapy (OR = 0.46), radiation therapy (OR = 0.52). This was reflected in each U.S. Census region, with the lowest odds of being treated with triple therapy, surgical resection, chemotherapy, and radiation therapy in New England (OR = 0.51) Mountain (OR = 0.66), West North Central (OR = 0.38), and the Middle Atlantic (OR = 0.44), respectively. Multivariable analysis revealed multiple socioeconomic parameters that significantly predicted lower odds of triple therapy in the elderly.
In the United States alone, there exists geographic disparity in the treatment outcomes of elderly GBM patients. Multiple socioeconomic parameters can influence access to treatment modalities for elderly patients compared to younger patients in different geographic regions, and public health initiatives targeting these aspects may prove beneficial conceptually to optimize and homogenize clinical outcomes.
老年（年龄>65岁）胶质母细胞瘤（GBM）患者的治疗可能受到多种地理和社会经济参数的影响。相应地，本研究的目的是确定美国老年GBM患者的治疗趋势。
回顾性分析2005年至2016年美国国家癌症数据库中所有GBM患者。按美国人口普查区域总结并分析三联疗法（手术切除、化疗和放疗）的治疗情况。
共纳入44338例GBM患者，其中老年患者21573例（49%），非老年患者22765例（51%），中位年龄分别为72岁（范围65 - 90岁）和47岁（范围40 - 64岁）。与非老年患者相比，老年患者接受三联疗法治疗的总体几率显著较低（优势比，OR = 0.54），其各个单独要素包括手术切除（OR = 0.78）、化疗（OR = 0.46）、放疗（OR = 0.52）。这在美国每个人口普查区域都有体现，新英格兰地区（OR = 0.51）、山区（OR = 0.66）、西中北部（OR = 0.38）和大西洋中部（OR = 0.44）接受三联疗法、手术切除、化疗和放疗的几率最低。多变量分析显示多个社会经济参数显著预测了老年患者接受三联疗法的较低几率。
仅在美国，老年GBM患者的治疗结果就存在地理差异。与不同地理区域的年轻患者相比，多个社会经济参数会影响老年患者获得治疗方式的机会，针对这些方面的公共卫生举措在概念上可能有助于优化和统一临床结果。
