Abstract
ObjectIncreasing age is a known negative prognostic factor for glioblastoma. However, a multifactorial approach is necessary to achieve optimal neuro-oncological treatment. It remains unclear to what extent frailty, comorbidity burden, and obesity might exert influence on survival in geriatric glioblastoma patients. We have therefore reviewed our institutional database to assess the prognostic value of these factors in elderly glioblastoma patients.MethodsBetween 2012 and 2018, patients aged ≥ 65 years with newly diagnosed glioblastoma were included in this retrospective analysis. Patients frailty was analyzed using the modified frailty index (mFI), while patients comorbidity burden was assessed according to the Charlson comorbidity index (CCI). Body mass index (BMI) was used as categorized variable.ResultsA total of 110 geriatric patients with newly diagnosed glioblastoma were identified. Geriatric patients categorized as least-frail achieved a median overall survival (mOS) of 17 months, whereas most frail patients achieved a mOS of 8 months (p = 0.003). Patients with a CCI > 2 had a lower mOS of 6 months compared to patients with a lower comorbidity burden (12 months; p = 0.03). Multivariate analysis identified “subtotal resection” (p = 0.02), “unmethylated MGMT promoter status” (p = 0.03), “BMI < 30” (p = 0.04), and “frail patient (mFI ≥ 0.27)” (p = 0.03) as significant and independent predictors of 1-year mortality in geriatric patients with surgical treatment of glioblastoma (Nagelkerke's R2 0.31).ConclusionsThe present study concludes that both increased frailty and comorbidity burden are significantly associated with poor OS in geriatric patients with glioblastoma. Further, the present series suggests an obesity paradox in geriatric glioblastoma patients.
Highlights
IntroductionMaximally safe surgery and adjuvant therapy have been the standard of care in glioblastoma treatment for many years, the management of elderly patients remains a challenge due to the increased incidence of treatment-related toxicities and slower recovery rates [1,2,3,4,5]
Maximally safe surgery and adjuvant therapy have been the standard of care in glioblastoma treatment for many years, the management of elderly patients remains a challenge due to the increased incidence of treatment-related toxicities and slower recovery rates [1,2,3,4,5].The challenge for optimal treatment of glioblastoma in geriatric patients resides in the balance between maximum radicality and reduction of intervention-related adverse events, which must be determined individually
Median Overall survival (OS) for geriatric patients with glioblastoma was 11 months
Summary
Maximally safe surgery and adjuvant therapy have been the standard of care in glioblastoma treatment for many years, the management of elderly patients remains a challenge due to the increased incidence of treatment-related toxicities and slower recovery rates [1,2,3,4,5]. The challenge for optimal treatment of glioblastoma in geriatric patients resides in the balance between maximum radicality and reduction of intervention-related adverse events, which must be determined individually. For elderly patients, specific aspects are important for a better assessment of treatment progression/success, such as a more detailed assessment of physical resources and function before each treatment. We have analyzed our institutional database with regard to a potential impact of the abovementioned pre-, peri- as well as immediately postoperatively collectable parameters on the success of treatment in geriatric patients with newly diagnosed glioblastoma
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