Table_1_Prognostic and Predictive Factors in Elderly Patients With Glioblastoma: A Single-Center Retrospective Study.DOCX

Glioblastoma (GBM) is the most common primary malignant intracranial tumor and the median age at diagnosis is 65 years. However, elderly patients are usually excluded from clinical studies and age is considered as an independent negative prognostic factor for patients with GBM. Therefore, the best treatment method for GBM in elderly patients has remained controversial. Elderly GBM patients (≥ 60 years old) treated between January 2015 and December 2019 were enrolled in this study. Medical records were reviewed retrospectively, and clinicopathological characteristics, treatments, and outcomes were analyzed. A total of 68 patients were included, with a median age of 65.5 years (range: 60–79). The median preoperative Karnofsky performance scale (KPS) score was 90 (range 40–100) and median postoperative KPS score was 80 (range 0–90). Univariate analysis results showed that age, gender, comorbidities, preoperative KPS < 90 and MGMT promoter methylation were not significantly associated with PFS and OS. On the other hand, total resection, postoperative KPS ≥ 80, Ki67 > 25%, and Stupp-protocol treatment were significantly associated with prolonged PFS and OS. Moreover, multivariate analysis found that postoperative KPS ≥ 80, total resection, and Stupp-protocol treatment were prognostic factors for PFS and OS. The findings of this study have suggested that, on the premise of protecting function as much as possible, the more aggressive treatment regimens may prolong survival for elderly patients with GBM. However, further studies, particularly prospective randomized clinical trials, should be conducted to provide more definitive data on the appropriate management of elderly patients, especially for patients with MGMT promoter methylation.

胶质母细胞瘤（Glioblastoma, GBM）是最常见的原发性颅内恶性肿瘤，患者诊断时的中位年龄为65岁。然而老年患者通常被排除在临床研究之外，且年龄被视为GBM患者独立的不良预后因素，因此老年GBM患者的最佳治疗方案至今仍存在争议。本研究纳入2015年1月至2019年12月期间接受治疗的老年GBM患者（年龄≥60岁），对其病历资料进行回顾性分析，系统评估患者的临床病理特征、治疗方案及预后结局。最终共计纳入68例患者，中位年龄为65.5岁（年龄范围60~79岁）；患者术前卡氏功能状态评分（Karnofsky Performance Scale, KPS）中位值为90分（范围40~100分），术后KPS中位值为80分（范围0~90分）。单因素分析结果显示，年龄、性别、合并症、术前KPS<90分以及O6-甲基鸟嘌呤-DNA甲基转移酶（MGMT）启动子甲基化状态与患者的无进展生存期（Progression-Free Survival, PFS）和总生存期（Overall Survival, OS）无显著相关性；反之，肿瘤全切除、术后KPS≥80分、Ki67指数>25%以及Stupp方案治疗与患者更长的PFS和OS显著相关。多因素分析进一步证实，术后KPS≥80分、肿瘤全切除以及Stupp方案治疗是影响患者PFS和OS的独立预后因素。本研究结果提示，在尽可能保护患者神经功能的前提下，采取更为积极的治疗方案或可延长老年GBM患者的生存时间。但仍需开展进一步研究，尤其是前瞻性随机对照临床试验，以明确老年GBM患者（尤其伴MGMT启动子甲基化的患者）的最优诊疗策略。