Prognostic factors in elderly patients with grade 3 gliomas.

Abstract

2093 Background: Anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and anaplastic oligoastrocytoma (AOA) are the major histological categories of WHO grade 3 gliomas. There is very limited data on specific prognostic factors in elderly patients (pts) with grade 3 gliomas, therefore we undertook this project to identify prognostic factors in elderly grade 3 glioma pts. Methods: After obtaining IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center’s database was used to identify pts with histologically confirmed grade 3 glioma ≥65 years of age at time of diagnosis. Multivariable analysis was conducted with use of a Cox proportional hazards model and a stepwise selection algorithm that used p<.10 as the criteria for entry and p<0.05 as retention in the model to identify independent predictors of survival. Results: Charts of 96 pts (52% of whom were men) diagnosed between 1994 and 2009 were reviewed. The median age at presentation was 71 years (range: 65-88 years). 65% of pts had biopsy only, 15 % had gross total resection (GTR), 1% had near total resection (NTR), and 19% had subtotal resection (STR). 92% of pts underwent radiation, 48% had concurrent chemotherapy. Median overall survival (OS) of AA, AOA, AO was 5.7 months, 22.5 months and 65.2 months respectively. Median OS for all pts was 6.7 months. On multivariable analysis, two factors were identified as independent predictors of overall survival, histology (AA vs. AO, p<.022) and Karnofsky Performance Status (p<.018). Conclusions: Poor performance status and AA were associated with higher risk of mortality. Risk factors for mortality Variable HR 95% CI P value Univariable analysis Gender Male vs female 0.84 0.53-1.34 0.47 Race (n=94) Caucasian vs Non-Caucasian 0.51 0.12-2.11 0.35 Age at diagnosis Per 10-year increase 1.14 0.76-1.70 0.53 KPS pre-RT (n=66) 30-60 vs. 90-100 2.44 1.15-5.18 0.021 70-80 vs. 90-100 2.22 1.11-4.42 0.023 Seizure at presentation Yes vs. No 0.53 0.31-0.90 0.018 Motor Signs Yes vs. No 1.43 0.90-2.27 0.13 Histology (n=94) Astro vs. Oligo 4.54 1.73-11.95 0.002 Mixed vs. Oligo 1.86 0.56-6.14 0.31 Type of surgery Biopsy vs. resection 1.82 1.10-3.00 0.020 Multivariable analysis KPS 30-60 vs. 90-100 2.57 1.18-5.61 <0.018 70-80 vs. 90-100 1.90 0.95-3.82 0.07 Histology Astro vs. Oligo 4.23 1.22-14.60 0.022 Mixed vs. Oligo 3.10 0.68-14.19 0.14