Fogg David, Gersey Zachary C, Pease Matthew, Mallela Arka N, Andrews Edward, Plute Tritan, Pearce Thomas M, Njoku-Austin Confidence, Anthony Austin, Amankulor Nduka M, Zinn Pascal
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
World Neurosurg. 2023 Oct;178:e540-e548. doi: 10.1016/j.wneu.2023.07.116. Epub 2023 Jul 28.
The current standard of care for patients with glioblastoma (GBM) is maximal safe resection followed by adjuvant radiation therapy with concurrent temozolomide chemotherapy. Previous studies that identified this treatment regimen focused on younger patients with GBM. The proportion of patients with GBM over the age of 80 years is increasing. We investigate whether elderly patients benefit from the current standard of care with additional maximal safe resection.
Clinical, operative, radiographic, demographic, genetic, and outcomes data were retrospectively collected for patients treated for histologically confirmed World Health Organization grade 4 GBM at University of Pittsburgh Medical Center from 2009 to 2020. Only patients 80 years and older were included (n = 123). Statistically significant values were set at P < 0.05.
A univariate Cox proportional hazards analysis of GBM patients aged >80 years identified the use of temozolomide, radiation, Karnofsky Performance Status (KPS) > 70, and methylguanine DNA methyltransferase methylation with increased overall survival (OS). Further multivariate Cox proportional hazards model analysis showed that the variables identified in the univariate analysis passed multicollinearity testing, and that use of temozolomide, KPS >70, and gross total resection were shown to significantly impact survival. Survival analysis showed that patients with biopsy alone had a shorter median OS compared with patients who received resection, temozolomide, and radiation (P < 0.0001, median OS 1.6 vs. 7.5 months). Additionally, patients who underwent biopsy and then received temozolomide and radiation had a shorter median OS when compared with patients who received resection, temozolomide, and radiation (P = 0.0047, median OS 3.6 vs. 7.5 months).
For elderly patients with KPS >70, GTR followed by radiation and temozolomide is associated with maximum OS.
胶质母细胞瘤（GBM）患者当前的标准治疗方案是进行最大安全切除，随后进行辅助放疗并同步使用替莫唑胺化疗。以往确定该治疗方案的研究主要聚焦于年轻的GBM患者。80岁以上GBM患者的比例正在增加。我们研究老年患者是否能从当前的标准治疗方案以及额外的最大安全切除中获益。
回顾性收集2009年至2020年在匹兹堡大学医学中心接受组织学确诊为世界卫生组织4级GBM治疗的患者的临床、手术、影像学、人口统计学、基因和结局数据。仅纳入80岁及以上的患者（n = 123）。统计学显著性值设定为P < 0.05。
对年龄大于80岁的GBM患者进行单变量Cox比例风险分析发现，使用替莫唑胺、放疗、卡氏功能状态评分（KPS）> 70以及甲基鸟嘌呤DNA甲基转移酶甲基化与总生存期（OS）延长相关。进一步的多变量Cox比例风险模型分析表明，单变量分析中确定的变量通过了多重共线性检验，并且使用替莫唑胺、KPS >70和全切除被证明对生存有显著影响。生存分析表明，仅接受活检的患者的中位OS比接受切除、替莫唑胺和放疗的患者短（P < 0.0001，中位OS 1.6个月对7.5个月）。此外，接受活检然后接受替莫唑胺和放疗的患者的中位OS比接受切除、替莫唑胺和放疗的患者短（P = 0.0047，中位OS 3.6个月对7.5个月）。
对于KPS >70的老年患者，全切除后进行放疗和替莫唑胺治疗与最长的OS相关。
