Personalised Oncology Division, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.
Department of Medical Oncology, Alfred Health, Prahran, VIC, Australia.
J Neurooncol. 2024 Jun;168(2):299-306. doi: 10.1007/s11060-024-04668-5. Epub 2024 Apr 17.
The impact of age on optimal management of glioblastoma remains unclear. A recent combined analysis of two randomised trials, GEINO14-01 and EX-TEM, found no benefit from extending post-radiation temozolomide in newly diagnosed glioblastoma. Here, we explore the impact of age.
Relevant intergroup statistics were used to identify differences in tumour, treatment and outcome characteristics based on age with elderly patients (EP) defined as age 65 years and over. Survival was estimated using the Kaplan Meier method.
Of the combined 205 patients, 57 (28%) were EP. Of these, 95% were ECOG 0-1 and 65% underwent macroscopic resection compared with 97% and 61% of younger patients (YP) respectively. There were numerically less MGMT-methylated (56% vs. 63%, p = 0.4) and IDH-mutated (4% vs. 13%, p = 0.1) tumours in EP vs. YP. Following surgery, EP were more likely to receive short course chemoradiation (17.5% vs. 6%, p = 0.017). At recurrence, EP tended to receive or best supportive care (28.3% vs. 15.4%, p = 0.09) or non-surgical options (96.2% vs. 84.6%, p = 0.06), but were less likely to receive bevacizumab (23.1% vs. 49.5%, p < 0.01). Median PFS was similar at 9.3months in EP and 8.5months in YP, with similar median OS at 20months.
In this trial population of predominantly fit EP, survival was similar to YP despite a proportion receiving less aggressive therapy at diagnosis and recurrence. Advancing age does not appear to be an adverse prognostic factor for glioblastoma when patients are fit for treatment, and a less aggressive approach in selected patients may not compromise outcomes.
年龄对胶质母细胞瘤最佳治疗方案的影响尚不清楚。最近对两项随机试验（GEINO14-01 和 EX-TEM）的联合分析发现，在新诊断的胶质母细胞瘤中，放疗后延长替莫唑胺的应用并不能带来获益。本研究旨在探讨年龄的影响。
利用相关组间统计学方法，根据年龄将患者分为老年组（EP，年龄≥65 岁）和年轻组（YP），并识别两组间肿瘤、治疗和预后特征的差异。采用 Kaplan-Meier 法评估生存情况。
在 205 例患者中，57 例（28%）为 EP。其中，95%的 EP 患者的 ECOG 评分为 0-1，65%的患者接受了大体全切除，而 YP 患者中分别为 97%和 61%。EP 患者中 MGMT 甲基化肿瘤比例（56% vs. 63%，p=0.4）和 IDH 突变肿瘤比例（4% vs. 13%，p=0.1）均低于 YP。术后，EP 更倾向于接受短程放化疗（17.5% vs. 6%，p=0.017）。复发时，EP 更倾向于接受或仅接受最佳支持治疗（28.3% vs. 15.4%，p=0.09）或非手术治疗（96.2% vs. 84.6%，p=0.06），但接受贝伐珠单抗治疗的比例较低（23.1% vs. 49.5%，p<0.01）。EP 的中位 PFS 为 9.3 个月，YP 为 8.5 个月，中位 OS 分别为 20 个月和 18 个月。
在本试验人群中，EP 患者的中位 OS 与 YP 相似，尽管 EP 患者在诊断和复发时接受的治疗更具侵袭性。在患者适合治疗的情况下，年龄增长似乎不是胶质母细胞瘤的不利预后因素，在选择的患者中采用较不激进的治疗方法可能不会影响预后。
