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Multicenter Study
. 2018 Nov;140(2):329-339.
doi: 10.1007/s11060-018-2957-7. Epub 2018 Aug 3.

Characteristics and outcomes of elderly patients with diffuse gliomas: a multi-institutional cohort study by Kansai Molecular Diagnosis Network for CNS Tumors

Takahiro Sasaki  1   2 , Junya Fukai  3   4 , Yoshinori Kodama  2   5   6 , Takanori Hirose  2   7 , Yoshiko Okita  2   8 , Shusuke Moriuchi  2   9 , Masahiro Nonaka  2   10 , Naohiro Tsuyuguchi  2   11 , Yuzo Terakawa  2   11 , Takehiro Uda  2   11 , Yusuke Tomogane  2   12 , Manabu Kinoshita  2   13 , Namiko Nishida  2   14 , Shuichi Izumoto  2   15 , Yoshikazu Nakajima  2   16 , Hideyuki Arita  2   17 , Kenichi Ishibashi  2   18 , Tomoko Shofuda  2   19 , Daisuke Kanematsu  2   20 , Ema Yoshioka  2   19 , Masayuki Mano  2   6 , Koji Fujita  1   2 , Yuji Uematsu  1   2 , Naoyuki Nakao  1   2 , Kanji Mori  2   21 , Yonehiro Kanemura  2   8   20
Affiliations
Multicenter Study

Characteristics and outcomes of elderly patients with diffuse gliomas: a multi-institutional cohort study by Kansai Molecular Diagnosis Network for CNS Tumors

Takahiro Sasaki et al. J Neurooncol. 2018 Nov.

Abstract

Introduction: This study investigates the current state of clinical practice and molecular analysis for elderly patients with diffuse gliomas and aims to elucidate treatment outcomes and prognostic factors of patients with glioblastomas.

Methods: We collected elderly cases (≥ 70 years) diagnosed with primary diffuse gliomas and enrolled in Kansai Molecular Diagnosis Network for CNS Tumors. Clinical and pathological characteristics were analyzed retrospectively. Various factors were evaluated in univariate and multivariate models to examine their effects on overall survival.

Results: Included in the study were 140 elderly patients (WHO grade II: 7, III: 19, IV: 114), median age was 75 years. Sixty-seven patients (47.9%) had preoperative Karnofsky Performance Status score of ≥ 80. All patients underwent resection (gross-total: 20.0%, subtotal: 14.3%, partial: 39.3%, biopsy: 26.4%). Ninety-six of the patients (68.6%) received adjuvant treatment consisting of radiotherapy (RT) with temozolomide (TMZ). Seventy-eight of the patients (75.0%) received radiation dose of ≥ 50 Gy. MGMT promoter was methylated in 68 tumors (48.6%), IDH1/2 was wild-type in 129 tumors (92.1%), and TERT promoter was mutated in 78 of 128 tumors (60.9%). Median progression-free and overall survival of grade IV cases was 8.2 and 13.6 months, respectively. Higher age (≥ 80 years) and TERT promoter mutated were associated with shorter survival. Resection and adjuvant RT + TMZ were identified as independent factors for good prognosis.

Conclusions: This community-based study reveals characteristics and outcomes of elderly glioma patients in a real-world setting. Elderly patients have several potential factors for poor prognosis, but resection followed by RT + TMZ could lengthen duration of survival.

Keywords: Diffuse glioma; Elderly; Glioblastoma; Molecular marker; Prognostic factor; Real-world data.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Kaplan–Meier survival curves according to age (a), preoperative KPS score (b), extent of surgical removal (c) and adjuvant treatment (d), adjuvant treatments in MGMT promotor methylated (e) or unmethylated (f) patients, TERT/MGMT interaction (g) in WHO Grade IV cases and IDH/TERT classification in WHO Grade II-IV cases (h)
Fig. 1
Fig. 1
Kaplan–Meier survival curves according to age (a), preoperative KPS score (b), extent of surgical removal (c) and adjuvant treatment (d), adjuvant treatments in MGMT promotor methylated (e) or unmethylated (f) patients, TERT/MGMT interaction (g) in WHO Grade IV cases and IDH/TERT classification in WHO Grade II-IV cases (h)
Fig. 1
Fig. 1
Kaplan–Meier survival curves according to age (a), preoperative KPS score (b), extent of surgical removal (c) and adjuvant treatment (d), adjuvant treatments in MGMT promotor methylated (e) or unmethylated (f) patients, TERT/MGMT interaction (g) in WHO Grade IV cases and IDH/TERT classification in WHO Grade II-IV cases (h)
See this image and copyright information in PMC

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