INTRODUCTION Elderly patients constitute an expanding part of our society. Due to a continuously increasing life expectancy, an optimal quality of life is expected even into advanced age. Glioblastoma (GBM) is more common in older patients, but they are still often withheld from efficient treatment due to worry of worse tolerance and have a significantly worse prognosis compared to younger patients. Our retrospective observational study aimed to investigate the therapeutic benefit from a second resection in recurrent glioblastoma of elderly patients. MATERIALS AND METHODS We included a cohort of 39 elderly patients (> 65 years) with a second resection as treatment option in the case of a tumor recurrence. A causal inference model was built by multiple non- and semiparametric models, which was used to identify matched patients from our elderly GBM database which comprises 538 patients. The matched cohorts were analyzed by a Cox-regression model adjusted by time-dependent covariates. RESULTS The Cox-regression analysis showed a significant survival benefit (Hazard Ratio: 0.6, 95% CI 0.36-0.9, p-value = 0.0427) for the re-resected group (18.0 months, 95% CI 13.97-23.2 months) compared to the group without re-resection (10.1 months, 95% CI 8.09-20.9 months). No differences in the co-morbidities or hemato-oncological side effects during chemotherapy could be detected. Anesthetic- and surgical complications were rare and comparable to the complication rate of patients undergoing the first-line resection. CONCLUSION Taken together, in elderly patients, re-resection is an acceptable treatment option in the recurrent state of a glioblastoma. The individual evaluation of the patients' medical status as well as the chances of withstanding general anesthesia needs to be done in close interdisciplinary consultation. If these requirements are met, elderly patients benefit from a re-resection.

中文翻译：

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老年患者复发性多形性胶质母细胞瘤的切除：伪随机分析显示了临床益处。

简介老年患者构成了我们社会的一个扩展部分。由于预期寿命的不断提高，即使到了老年也有望获得最佳的生活质量。胶质母细胞瘤（GBM）在老年患者中更为常见，但由于担心耐受性较差，与年轻患者相比，它们仍经常无法进行有效治疗。我们的回顾性观察研究旨在调查第二次切除对老年患者胶质母细胞瘤复发的治疗益处。材料与方法我们纳入了39名老年患者（> 65岁），并在肿瘤复发的情况下进行了第二次切除作为治疗选择。因果推理模型是由多个非参数和半参数模型建立的，从我们的老年人GBM数据库（包括538名患者）中识别出匹配的患者。通过由时变协变量调整的Cox回归模型分析匹配的队列。结果Cox回归分析显示，与再切除组（18.0个月，95％CI 13.97-23.2个月）相比，重新切除组具有显着的生存获益（危险比：0.6，95％CI 0.36-0.9，p值= 0.0427）。无再次切除的组（10.1个月，95％CI 8.09-20.9个月）。在化疗期间，没有发现并发或血液肿瘤副作用的差异。麻醉和手术并​​发症很少见，与一线切除患者的并发症发生率相当。结论在老年患者中，在胶质母细胞瘤复发状态中，再次切除是可接受的治疗选择。需要在跨学科的密切咨询中对患者的医疗状况以及承受全身麻醉的机会进行个体评估。如果满足这些要求，则老年患者将从再次切除中受益。