Kim Jina, Lee Hye In, Kim In Ah, Lee Joo Ho, Cho Jaeho, Wee Chan Woo, Yoon Hong In
Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Neurooncol Adv. 2023 Dec 28;6(1):vdad173. doi: 10.1093/noajnl/vdad173. eCollection 2024 Jan-Dec.
We aimed to comprehensively investigate the prognostic value of pretreatment laboratory parameters in elderly patients with glioblastoma treated with temozolomide (TMZ)-based chemoradiation.
Patients aged ≥ 65 years from 4 institutions with newly diagnosed IDH-wild-type glioblastoma who received radiotherapy (RT) with concurrent TMZ between 2006 and 2021 were included. Patient factors (age, Karnofsky performance status (KPS), temporalis muscle thickness), molecular factors (MGMT promoter methylation, EGFR amplification, TERT promoter mutation, and TP53 mutation status), treatment factors (extent of resection, and RT dose), and pretreatment laboratory parameters (serum De Ritis ratio, glucose level, neutrophil-to-lymphocyte ratio, platelet count, and systemic immune-inflammation index) were included in the analysis. The primary endpoint was overall survival (OS).
In total, 490 patients were included in the analysis. The median follow-up period was 12.3 months (range, 1.6-149.9 months). Median OS was significantly prolonged in patients with De Ritis ratio < 1.2 (18.2 vs 15.3 months, = .022) and in patients with glucose level < 150 mg/dL (18.7 vs 16.5 months, = .034) per univariate analysis. In multivariate analysis, KPS ≥ 70, MGMT promoter methylation, extent of resection greater than partial resection, De Ritis ratio < 1.2, and glucose level < 150 mg/dL were significant prognostic factors for improved OS.
Along with well-known prognostic factors, pre-RT serum biomarkers, including the De Ritis ratio and glucose level, also had prognostic value in elderly patients with glioblastoma treated with TMZ-based chemoradiation.
我们旨在全面研究预处理实验室参数对接受以替莫唑胺（TMZ）为基础的放化疗的老年胶质母细胞瘤患者的预后价值。
纳入了2006年至2021年间来自4家机构的年龄≥65岁、新诊断为异柠檬酸脱氢酶（IDH）野生型胶质母细胞瘤且接受同步TMZ放疗（RT）的患者。分析包括患者因素（年龄、卡诺夫斯基性能状态（KPS）、颞肌厚度）、分子因素（O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化、表皮生长因子受体（EGFR）扩增、端粒酶逆转录酶（TERT）启动子突变和TP53突变状态）、治疗因素（切除范围和放疗剂量）以及预处理实验室参数（血清德瑞蒂斯比值、血糖水平、中性粒细胞与淋巴细胞比值、血小板计数和全身免疫炎症指数）。主要终点为总生存期（OS）。
总共490例患者纳入分析。中位随访期为12.3个月（范围1.6 - 149.9个月）。单因素分析显示，德瑞蒂斯比值<1.2的患者中位OS显著延长（18.2对15.3个月，P = 0.022），血糖水平<150 mg/dL的患者中位OS也显著延长（18.7对16.5个月，P = 0.034）。多因素分析中，KPS≥70、MGMT启动子甲基化、切除范围大于部分切除、德瑞蒂斯比值<1.2以及血糖水平<150 mg/dL是OS改善的显著预后因素。
除了众所周知的预后因素外，放疗前血清生物标志物，包括德瑞蒂斯比值和血糖水平，对接受以TMZ为基础的放化疗的老年胶质母细胞瘤患者也具有预后价值。
