OBJECTIVE We examine the impact of age and extent of resection (EOR) on overall survival (OS) in geriatric patients with Glioblastoma (GBM). METHODS The SEER 18 Registries was used to identify patients aged 65 and above with GBM from 2000-2016. Patients were categorized into 4 groups based on EOR: Biopsy/Local Excision (B/LE), Subtotal Resection (STR), Gross Total Resection (GTR), and Supratotal Resection (SpTR). Primary endpoint was OS, which was calculated using the Kaplan-Meier method and analyzed by the Log-rank and Wilcoxon-Breslow-Gehan test. Multivariable Cox proportional hazards regression model was utilized to identify factors associated with OS. Likelihood of undergoing SpTR was explored using a multivariable logistic regression model. Results are given as median [IQR] and HR [95 % CI]. RESULTS Among 17,820 geriatric patients with GBM, median age was 73 years [68-78], 44 % were female, 91 % White, and 8% Hispanic. SpTR was performed in 2907 (16 %), GTR was performed in 2451 (14 %) patients, STR in 4879 (28 %), and B/LE in 7396 (42 %). There was a decline in the proportion of patients treated with SpTR with advancing age (65-69 years, 17 % vs 95+ years, 0%; p < 0.0001), and older age corresponded with a decrease in the odds of undergoing SpTR. In survival analysis, GTR (HR 0.61 [0.58-0.65]) and SpTR (HR 0.65 [0.62-0.68]) were associated with improved survival, even in octogenarian patients. CONCLUSIONS These findings suggest that aggressive surgical resection is associated with improvement in OS in geriatric patients. These results emphasize that age should not influence surgical strategy, as there is a survival benefit from maximal resection in geriatric patients.

中文翻译：

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老年胶质母细胞瘤患者的切除范围和生存结果：积极手术是否有益？

目的 我们研究了年龄和切除范围 (EOR) 对老年胶质母细胞瘤 (GBM) 总生存期 (OS) 的影响。方法 SEER 18 Registries 用于识别 2000-2016 年 65 岁及以上的 GBM 患者。根据 EOR 将患者分为 4 组：活检/局部切除 (B/LE)、次全切除 (STR)、总切除 (GTR) 和超全切除 (SpTR)。主要终点是 OS，使用 Kaplan-Meier 方法计算并通过 Log-rank 和 Wilcoxon-Breslow-Gehan 检验进行分析。多变量 Cox 比例风险回归模型用于识别与 OS 相关的因素。使用多变量逻辑回归模型探讨了接受 SpTR 的可能性。结果以中值 [IQR] 和 HR [95 % CI] 给出。结果 在 17,820 名 GBM 老年患者中，中位年龄为 73 岁 [68-78]，44% 为女性，91% 为白人，8% 为西班牙裔。2907 名患者 (16%) 进行了 SpTR，2451 名患者 (14%) 进行了 GTR，4879 名患者 (28%) 进行了 STR，7396 名 (42%) 患者进行了 B/LE。随着年龄的增长，接受 SpTR 治疗的患者比例有所下降（65-69 岁，17% 对 95 岁以上，0%；p < 0.0001），并且年龄越大，接受 SpTR 的几率下降。在生存分析中，即使在八十多岁的患者中，GTR (HR 0.61 [0.58-0.65]) 和 SpTR (HR 0.65 [0.62-0.68]) 与生存率的提高相关。结论 这些发现表明，积极的手术切除与老年患者 OS 的改善有关。这些结果强调年龄不应影响手术策略，因为对老年患者进行最大程度切除有生存益处。