Factors Associated with Increased Survival after Surgical Resection of Glioblastoma in Octogenarians

Abstract

Elderly patients with glioblastoma represent a clinical challenge for neurosurgeons and oncologists. The data available on outcomes of patients greater than 80 undergoing resection is limited. In this study, factors linked to increased survival in patients over the age of 80 were analyzed. A retrospective chart review of all patients over the age of 80 with a new diagnosis of glioblastoma and who underwent surgical resection with intent for maximal resection were examined. Patients who had only stereotactic biopsies were excluded. Immunohistochemical expression of oncogenic drivers (p53, EGFR, IDH-1) and a marker of cell proliferation (Ki-67 index) performed upon routine neuropathological examination were recorded. Stepwise logistic regression and Kaplan Meier survival curves were plotted to determine correlations to overall survival. Fifty-eight patients fit inclusion criteria with a mean age of 83 (range 80–93 years). The overall median survival was 4.2 months. There was a statistically significant correlation between Karnofsky Performance Status (KPS) and overall survival (P < 0.05). There was a significantly longer survival among patients undergoing either radiation alone or radiation and chemotherapy compared to those who underwent no postoperative adjuvant therapy (p < 0.05). There was also an association between overall survival and lack of p53 expression (p < 0.001) and lack of EGFR expression (p <0.05). In this very elderly population, overall survival advantage was conferred to those with higher preoperative KPS, postoperative adjuvant therapy, and lack of protein expression of EGFR and p53. These findings may be useful in clinical decision analysis for management of patients with glioblastoma who are octogenarians, and also validate the critical role of EGFR and p53 expression in oncogenesis, particularly with advancing age.

Ventricle contact is associated with lower survival and increased peritumoral perfusion in glioblastoma

“…5 It remains debatable whether or not the preoperative volume of contrast enhancement is a prognostic factor for survival, as extent of resection is usually seen as a better measure of outcome. 1,3,11,23,24,28,31 In our study we found a limited, yet significant, effect of volume of contrast enhancement on survival. However, the volume of contrast enhancement could not explain the difference between the patient groups, and ventricle contact was identified as a strong independent prognostic factor.…”

Analysis of Treatment Tolerance and Factors Associated with Overall Survival in Elderly Patients with Glioblastoma

“…It is therefore worth mentioning the immunohistochemical outcomes that were observed in 33 patients. Consistent with previous studies, 28,29 in our study, we found a statistically significant relationship between low p53 expression in protein immunostaining and longer survival times. It has been suggested that an increase in the expression of p53 is a response to DNA damage.…”

Glioblastoma Multiforme: an Advanced Analysis of 153 Patients and Review of the Literature

“…[27][28][29][30][31] Abdullah Kalil et al conducted a study on factors associated with increased survival after surgical resection on GBM patients of more than 80 years of age in which they found a statistically significant correlation between the KPS and overall survival. 30 In another study, Chaichana et al considered preoperative factors associated with decreased survival for older patients who underwent resection of a GBM, and found that one of the preoperative factors that was independently associated with decreased survival was a KPS score of less than 80. 31 Chaichana et al, in another study, evaluated functional outcomes over time for patients with glioblastoma, and found that a preoperative KPS score of !…”