| Background and Objective:Gliomas are the most common primary intracranial malignant tumors in adults.Among them,high grade glioma(HHG),especially glioblastoma(GBM),WHO grade IV glioma is the most malignant with the worst prognosis.And the incidence of glioma will increase with age.In terms of the definition of older persons,the NCCN guidelines differ from those of the World Health Organization(WHO).While WHO stipulates that 60 years old can be defined as old persons,the NCCN guidelines set 65 years as the threshold for entering old age.For high grade glioma patients,due to the significant increase in morbidity in GBM patients over 65 years of age,and the poor prognosis of them,this article choose NCCN guidelines to define "old age" which is 65 years old.Due to the poor performance state of the elderly and the high incidence of comorbidity,this group of patients has poor tolerance to surgery and postoperative radiotherapy and chemotherapy.Therefore,develop a series of effective assessments before treatment and screening out patients who will benefit from treatment is particularly important.At the same time,because the therapeutic effect in this group of patient is not satisfied,it is very significant to analyze the therapeutic regimen of these patients.Fully evaluating the state of pre-treatment patients and choosing the most suitable therapeutic regimen may be the research direction of the elderly patients with high grade gliomas in the future,so as to better realize the precision medicine and individualized medicine.MethodsA retrospective study was conducted at Peking Union Medical College Hospital(PUMCH),Beijing,China.Files were retrieved from the hospital archives by screening records from April 2012 to August 2017.A total of 63 elderly patients with high grade glioma were treated in this period,and the detailed follow-up information which can be obtained in 32 of them was statistically analyzed.The data included:(1)the clinical characteristics of the patients,including general performance status,comorbidities,the most common symptom,the location of the lesion and the pathological classification.The general performance status was evaluated by Kamofsky Performance Status(KPS),and the Charlson comorbidity index(CCI)was used to evaluate the severity of comorbidity.(2)The therapeutic regimen of these patients,especially the surgery.(3)The prognosis of these patients,that is to say,the overall survival.The data that need to be analyzed include:(1)the correlation analysis between two different surgical treatments(biopsy and resection)and the survival of the patients;(2)the clinical characteristics of the patients,that is,the correlation between the general performance status,the comorbidity index and the survival time of these patients.Survival time analysis was carried out with SPSS 24.0 software.Chi-square test was used to compare counting data and variance analysis was used to compare metrological data.The survival rate was calculated by Kaplan-Meier method and the difference of survival rate was analyzed by Log-rank test.The difference was statistically significant when P<0.05.Results:A total of 63 elderly patients with high grade glioma were included in this study.The results were as follows:there are 21 male patients and 11female patients.Their age range from 65 to 79 years old,and the mean age was 71.9 years old;Among them,there were 22 cases with WHO ? grade glioblastoma,accounting for 68.75%of all patients,and 10 cases with WHO grade ? gliomas,accounting for 31.25%of all patients.Among the 32 patients,the most common symptoms were limb weakness(13 cases),accounting for 40.6%of all patients.The other more common symptoms included:dyslexia,headache and epilepsy.The most common location of tumor was frontal lobe,and multiple lesions were also common,both of them were 10 patients,accounting for 31.25%of the total number,and the range of Charlson comorbidity index was 4 to 8,the average score was 5.66.The KPS score ranged from 40 to 90,with an average of 78.13.Of the 32 patients analyzed,11 patients(34.4%)underwent biopsy and 21 patients(65.6%)underwent resection.The median survival time of them was 15.83 months.Conclusions:The general performance status of elderly patients with high grade glioma is worse than that of normal adults,and the comorbidity situations are more complicated.However,these two clinical characteristics can not be used as independent predictors of the overall survival of the patients in this study.At the same time,we compared the survival time of the patients undergoing biopsy and resection,and found that there was no significant difference between the two groups.These negative results may be associated with other complex factors,such as the small number of patients in the group and the variety of other treatment options after the operation.However,through the discussion and analysis of the results and the review of previous relevant literature,it can still be concluded that comprehensive consideration should be given to the various indicators of the elderly patients with high grade gliomas when formulating a diagnosis and therapeutic regimen for the elderly patients with high grade gliomas.In order to achieve the best therapeutic effect. |
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