老年高级别胶质瘤临床特点及预后分析

Analysis on the clinical characteristics and prognosis of elderly patients with high-grade glioma

目的总结老年高级别胶质瘤的临床特点、预后因素及治疗模式。方法收集2008年1月至2021年1月广东三九脑科医院确诊的84例老年高级别胶质瘤患者(≥65岁)临床资料,分析临床特点及预后影响因素。结果术后卡氏功能状态(KPS)评分、组织类型、O6-甲基鸟嘌呤-DNA甲基转移酶(MGMT)状态、手术方式、术后治疗模式、是否维持化疗、维持化疗周期数是影响总生存期的相关因素(P<0.05)。术前KPS评分和放疗完成情况无关(P>0.05);术后KPS评分和放疗完成情况有关(P<0.05)。多因素Cox回归模型显示,MGMT免疫组织化学阴性、维持化疗周期数≥6个为预后良好因素(P<0.05)。结论老年高级别胶质瘤行最大范围的安全切除有生存获益,术后建议行积极的放疗为主的综合治疗,但何种分隔方式最优仍需进一步探讨。MGMT免疫组织化学阴性可从替莫唑胺治疗中获益,长周期的维持化疗能使生存期进一步延长。

Objective To summarize the clinical features,prognostic factors,and treatment patterns of elderly high-grade gliomas.Methods The clinical data of 84 elderly patients with high-grade glioma(≥65 years old)diagnosed in Guangdong Sanjiu Brain Hospital from January 2008 to January 2021 were collected,and the clinical characteristics and prognostic factors were analyzed.Results Postoperative Karnofsky performance status(KPS)score,histological type,O6-methylguanine-DNA methyltransferase(MGMT)status,surgical method,postoperative treatment mode,whether to maintain chemotherapy,and the number of maintenance chemotherapy cycles were related factors affecting overall survival(P<0.05).Preoperative KPS score was not related to the completion of radiotherapy(P>0.05);postoperative KPS score was related to the completion of radiotherapy(P<0.05).Multivariate Cox regression model showed that negative MGMT immunohistochemistry and≥six cycles of maintenance chemotherapy were prognostic factors(P<0.05).Conclusion For elderly high-grade gliomas,the maximum range of safe resection has a survival benefit.It is recommended to perform comprehensive treatment with active radiotherapy after surgery.However,the optimal separation method still needs to be further explored.Negative MGMT immunohistochemistry can benefit from temozolomide treatment,and long-term maintenance chemotherapy can further prolong survival.