老年高级别胶质瘤的临床特点和治疗

目的探讨老年高级别胶质瘤患者的临床特点和治疗方案。方法回顾性分析2012年4月至2017年8月中国医学科学院,北京协和医院神经外科连续收治的32例老年高级别胶质瘤患者的临床资料,总结其临床表现、术前Karnofsky功能状态评分(KPS)、合并症情况(查尔森合并症指数)、肿瘤病理学分型、治疗方法以及患者的总生存期。所有患者均行手术切除肿瘤或活组织检查术,术后辅以放化疗、单纯化疗或靶向治疗。采用Kaplan-Meier法探讨手术方式、合并症情况以及术前KPS对患者总生存期的影响。结果32例患者中,男21例,女11例;年龄为(71.9±6.9)岁(65~79岁);其中世界卫生组织(WHO)Ⅳ级(胶母细胞瘤)22例(68.7%),Ⅲ级10例(31.3%);术前中位KPS(范围)为78.1分(40~90分);中位查尔森合并症指数(范围)为5.7(4~8)。32例患者中,行病灶切除术21例(65.6%),行活组织检查术11例(34.4%)。术后行标准Stupp方案治疗7例,行替莫唑胺辅助化疗9例,行靶向治疗1例,未行进一步治疗11例。失访4例。32例患者的总生存期为1.2~73.3个月,中位值为15.8个月。生存分析结果表明,手术方式、术前KPS以及查尔森合并症指数并非患者总生存期的影响因素(均P>0.05)。结论老年高级别胶质瘤患者的一般情况较差,合并症多,通过采用手术、放化疗等综合治疗后生存期仍较短。在进行治疗方案的选择时,应根据患者的具体情况选择相对有利的治疗方案。

Clinical characteristics and treatment of high-grade gliomas in the elderly patients

Objective To investigate the clinical characteristics and treatment regimens of high-grade gliomas in the elderly patients.Methods A retrospective study including 32 elderly patients with high-grade gliomas was conducted.Those patients were consecutively admitted to Department of Neurosurgery,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences from April 2012 to August 2017 and enrolled into this study.Clinical characteristics,Karnofsky performance status(KPS),comorbidities(Charlson comorbidity index),tumor pathology classification,treatment regimen and overall patient survival were analyzed.All patients underwent tumor resection or biopsy,followed by concurrent chemoradiotherapy,chemotherapy,or targeted therapy.The Kaplan-Meier method was used to explore the effects of surgical methods,comorbidities and KPS on the overall survival of patients.Results The patients enrolled into this study included 21 males and 11 females.Their age ranged from 65 to 79 years old with an average of 71.9±6.9 years old.Among them,there were 22(68.7%)cases with glioblastomaWorld Health Organization(WHO)gradeⅣ]and 10(31.3%)cases with WHO gradeⅢgliomas.The median KPS score was 78.1(range:40-90).The range of assessment results based on Charlson comorbidity index was 4 to 8 with a median of 5.7.Of the 32 patients,21 patients(65.6%)underwent resection and 11(34.4%)underwent biopsy.Seven patients underwent standard Stupp regimen after operation,9 patients received temozolomide adjuvant chemotherapy without radiotherapy,1 patient received targeted therapy,and 11 patients received no further treatment.Four cases were lost to follow-up.The median survival time of 32 patients was 15.8 months(range:1.2-73.3 months).Survival analysis showed that surgical methods,preoperative KPS,and Charlson comorbidity index were not factors influencing overall survival of patients(all P>0.05).Conclusions Elderly patients with high-grade gliomas are generally in poor health conditions and have multiple comorbidities.Despite having undergone comprehensive treatment,including surgery,radiotherapy and chemotherapy,survival of those patients still seems to be relatively short.Therefore,when deciding treatment regimen,a relatively favorable treatment plan should be selected according to the specific conditions of the patient.