Grant R, Liang B C, Page M A, Crane D L, Greenberg H S, Junck L
Department of Neurology, University of Michigan, Ann Arbor, USA.
Neurology. 1995 May;45(5):929-33. doi: 10.1212/wnl.45.5.929.
In patients with cerebral astrocytomas treated with nitrosourea-based chemotherapy, to determine whether age is predictive of response, time to progression, survival, or rate of complications.
Retrospective analysis of neuroimaging studies and clinical data.
University hospital with a busy neuro-oncology service.
One hundred forty-eight patients with pathologically confirmed malignant astrocytomas or recurrent astrocytomas.
Partial response occurred in 39% of patients aged < 40 years, in 17% of those aged 40 to 59, and in only 5% of those aged > or = 60 (p < 0.001). Median time to progression after chemotherapy was 23 weeks in patients aged < 60 and 6 weeks in patients aged > or = 60 (p < 0.001). Median survival after chemotherapy was 43 weeks in patients aged < 60 but only 24 weeks in patients aged > or = 60 (p < 0.001). Differences between age groups in response rate, time to progression, and survival persisted with adjustment for tumor grade. The risk of myelosuppressive complications requiring hospitalization was significantly related to age (p = 0.03); such complications occurred in 35% of patients aged > or = 60 and 16% of patients under 60 years.
Age is strongly predictive of the likelihood of a response to chemotherapy, time to progression, survival, and risk of myelosuppressive complications. Patients aged > or = 60 have a lower change of benefit and an increased risk of myelosuppressive complications from chemotherapy for astrocytomas compared with younger patients.
在接受基于亚硝基脲化疗的脑星形细胞瘤患者中，确定年龄是否可预测反应、疾病进展时间、生存期或并发症发生率。
对神经影像学研究和临床数据进行回顾性分析。
拥有繁忙神经肿瘤服务的大学医院。
148例经病理证实的恶性星形细胞瘤或复发性星形细胞瘤患者。
年龄<40岁的患者中39%出现部分缓解，40至59岁的患者中17%出现部分缓解，而年龄≥60岁的患者中仅5%出现部分缓解（p<0.001）。化疗后年龄<60岁患者的疾病进展中位时间为23周，年龄≥60岁患者为6周（p<0.001）。化疗后年龄<60岁患者的中位生存期为43周，而年龄≥60岁患者仅为24周（p<0.001）。在对肿瘤分级进行校正后，各年龄组在缓解率、疾病进展时间和生存期方面的差异仍然存在。需要住院治疗的骨髓抑制并发症风险与年龄显著相关（p=0.03）；此类并发症在年龄≥60岁的患者中发生率为35%，在60岁以下患者中为16%。
年龄强烈预测化疗反应的可能性、疾病进展时间、生存期以及骨髓抑制并发症风险。与年轻患者相比，年龄≥60岁的星形细胞瘤患者从化疗中获益的可能性较低，且发生骨髓抑制并发症的风险增加。
