Neurosurgery Unit, "Città Della Salute E Della Scienza" University Hospital, Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10124, Turin, Italy.
Section of Geriatrics, "Città Della Salute E Della Scienza" University Hospital, Department of Medical Sciences, University of Turin, Turin, Italy.
Neurosurg Rev. 2024 Oct 25;47(1):823. doi: 10.1007/s10143-024-03052-1.
High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75 years. A prognostic score will be proposed to guide surgical decisions based on expected survival. Retrospective observational single-center cohort study was carried out at the "Città della Salute e della Scienza-Molinette" University Hospital in Turin, Italy. All consecutive patients aged ≥ 75 years newly diagnosed with HGG were included, regardless of whether they underwent surgical resection. Clinical, radiological, histological and molecular data were collected.Variables potentially available at the time of diagnosis were considered to develop a multivariable logistic regression predictive model, with 12-months overall survival as the dependent variable. 102 patients aged 75 years or older received a new diagnosis of high-grade glioma, of whom 68 underwent surgical resection. Patients undergoing surgery were slightly younger (76.9 vs 79.0 years, p = 0.007) and had better performance status (median KPS 80 vs 70). Most tumors undergoing surgery were localized in cortical or subcortical non-motor areas (p < 0.001) and less frequently deep-seated (p = 0.023) or multifocal (p < 0.001). A predictive model, the DAK-75 score, was developed: the AUROC of the final model was 0.822 (95% CI 0.741-0.902). The score includes clinical presentation, tumor location, and KPS, ranging from 0 to 20, categorizing risk scores into low-risk and high-risk groups (< or > 8). Higher scores corresponded to fewer surgical patients and higher one-year mortality rates (92.2% vs 47.1%, p < 0.001). DAK-75 score may represent a valuable tool in the decision-making process for neurosurgical intervention in elderly patients diagnosed with HGG. Further studies are needed to externally and prospectively validate the scoring system.
高级别胶质瘤是成人中最常见的神经肿瘤疾病，其发病率随年龄增长而增加，在 70 岁达到高峰。本文旨在探讨如何通过识别新诊断的 HGG 患者 12 个月死亡率的术前预测因子，为年龄≥75 岁的患者选择手术切除。将提出一种预后评分，以根据预期生存指导手术决策。这是一项在意大利都灵的“Città della Salute e della Scienza-Molinette”大学医院进行的回顾性观察性单中心队列研究。所有新诊断为 HGG 且年龄≥75 岁的连续患者均被纳入研究，无论是否接受手术切除。收集了临床、影像学、组织学和分子数据。考虑了在诊断时可能存在的变量，以开发多变量逻辑回归预测模型，以 12 个月总生存率为因变量。102 名年龄在 75 岁或以上的患者被诊断为高级别胶质瘤，其中 68 名患者接受了手术切除。接受手术的患者年龄稍小（76.9 岁与 79.0 岁，p=0.007），表现状态更好（中位 KPS 为 80 分与 70 分）。大多数接受手术的肿瘤位于皮质或皮质下非运动区（p<0.001），较少位于深部（p=0.023）或多灶性（p<0.001）。开发了一种预测模型，即 DAK-75 评分：最终模型的 AUROC 为 0.822（95%CI 0.741-0.902）。该评分包括临床表现、肿瘤位置和 KPS，范围为 0 至 20 分，将风险评分分为低风险和高风险组（<8 或>8）。较高的评分与较少的手术患者和更高的一年死亡率（92.2%与 47.1%，p<0.001）相关。DAK-75 评分可能是老年 HGG 患者神经外科干预决策过程中的一个有价值的工具。需要进一步的研究来对外在和前瞻性验证评分系统。
