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Li T, Liu Y, Li J, Zuo M, Cheng Y. Do elderly patients (≥ 75 years old) with glioblastoma benefit from more radical surgeries in the era of temozolomide? Neurosurg Rev 2021; 45:741-750. [PMID: 34241729 DOI: 10.1007/s10143-021-01600-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/13/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023]
Abstract
This study assesses the effect of extent of resection (EOR) on the longer-term survival and early mortality of elderly patients (≥ 75 years old) with glioblastoma. We used the Surveillance, Epidemiology, and End Results (SEER) database and data from our center to evaluate the effect of EOR on the long-term survival and early mortality of patients with glioblastoma. We included 50 elderly patients (≥ 75 years old) with glioblastoma visiting our hospital. The median overall survival of the patients who underwent a gross total resection, a subtotal resection, and a partial resection were 278, 200, and 83 days, respectively. The multivariate analysis showed that gross total resection (HR: 0.100; 95% CI: 0.015-0.671, p < 0.001) and subtotal reresection (HR: 0.134, 95% CI: 0.022-0.831, p < 0.001) were independent predictors of favorable prognosis when compared with partial resection. The data extracted from the SEER database also indicated that EOR was an independent predictor of OS, CCS, and early mortality. The stratification analysis revealed that gross total resection was the best protective factor of OS, early mortality, and CCS. Radical resection may improve the OS and CCS of glioblastoma patients aged ≥ 75 years and decrease early mortality.
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Affiliation(s)
- Tengfei Li
- Department of Neurosurgery, West China Hospital, Sichuan Province, Chengdu, People's Republic of China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan Province, Chengdu, People's Republic of China
| | - Junhong Li
- Department of Neurosurgery, West China Hospital, Sichuan Province, Chengdu, People's Republic of China
| | - Mingrong Zuo
- Department of Neurosurgery, West China Hospital, Sichuan Province, Chengdu, People's Republic of China
| | - Yongzhong Cheng
- Department of Neurosurgery, West China Hospital, Sichuan Province, Chengdu, People's Republic of China.
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Ahmadipour Y, Rauschenbach L, Gembruch O, Darkwah Oppong M, Michel A, Pierscianek D, Stuschke M, Glas M, Sure U, Jabbarli R. To resect or not to resect? Risks and benefits of surgery in older patients with glioblastoma. J Geriatr Oncol 2020; 11:688-693. [DOI: 10.1016/j.jgo.2019.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 08/28/2019] [Accepted: 10/16/2019] [Indexed: 01/20/2023]
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3
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Clinical impact of circulating oncogenic MiRNA-221 and MiRNA-222 in glioblastoma multiform. J Neurooncol 2019; 144:545-551. [PMID: 31422498 DOI: 10.1007/s11060-019-03256-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Glioblastoma multiform (GBM); most fatal brain cancer, is incurable with molecular diversity hence identification of molecular targets that contribute to GBM tumorgenesis will be suitable for the development of diagnostic and treatment strategies. Micro-RNAs (miR); small RNA molecules, are stable in blood and play a crucial role in molecular processes in GBM. Thus it was aimed to investigate the clinical role of miR-221 and miR-222 among GBM cases as compared to healthy individuals and illustrate their role in patient's survival. MATERIALS AND METHODS Blood samples were withdrawn from 20 GBM cases before and after treatment, a group of 20 healthy individuals were served as control. For all enrolled samples expression of miR-221 and miR-222 were detected using quantitative PCR (QPCR). Sensitivities, specificities of investigated miRs and their relation with GBM clinical characteristics and patient's outcome were analyzed using Kaplan Meir curve. RESULTS Expression of investigated miR- 221 and -222 were significantly increased in GBM cases as compared to healthy individuals (F = 12.9, at P < 0.001, F = 28.78, at P < 0.0001, respectively) and with absolute specificity for both and 90% sensitivity for miR-221 and 85% for miR-222. Among GBM patients (n = 20), mean expression level miR-221 reported significant increase with elder GBM ( > 60 years) at F = 5.7, P = 0.028, while both miR-221 and -222 showed significant difference in performance status (ECGO) at P = 0.036 and 0.007, patients with primary lesion at P = 0.001 and 0.005, surgically treatment strategy at P < 0.001 and 0.004, respectively. Patients were grouped according to their outcomes into response (complete [CR] or partial [PR]), stable disease[SD] and progressive disease [PD], miR-221 and miR-222 showed increase expression with PD and patients with worse PFS and OS were those with high miRs expression. CONCLUSION Detection of circulating miR-221 and miR-222 may be used as circulating molecular marker for diagnosis and prediction of outcome for patients with GBM. Further studies with large cohort of samples are encouraged.
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Tanzilli A, Pace A, Fabi A, Telera S, Vidiri A, Carosi M, Terrenato I, Koudriavtseva T, Boccaletti R, Villani V. Neurocognitive evaluation in older adult patients affected by glioma. J Geriatr Oncol 2019; 11:701-708. [PMID: 31277954 DOI: 10.1016/j.jgo.2019.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Glioblastoma (GBM) has an increasing incidence and dismal prognosis in older adults. This study evaluated neurocognitive status of an older adult population with GBM and its correlation with clinical and demographical variables. METHODS Each patient underwent an extended neuropsychological evaluation by means of a battery of standardized tests describing eight cognitive domains: global function; verbal learning; short- and long-term memory (LTM); executive functions (EFs); abstract reasoning (AR); attention; and visuo-constructional abilities (CA). RESULTS We assessed 79 patients with GBM (median age: 74 years). Out of this initial sample, a subgroup of seventeen patients with six-month median time underwent a follow-up test session. 46 out of the 79 patients (58.2%) presented multi-domain cognitive impairment, 24 patients (30.3%) showed single-domain cognitive impairment and only seven (9%) showed no cognitive impairment. Kaplan Meier estimator showed that patients with AR deficit had a poorer prognosis in terms of progression-free survival and overall survival (p < .001). At the multivariate analysis AR (deficit vs non; hazard ratio (HR) = 5.07, 95%; confidence interval (CI): 1.91-13.46; p < .001) was correlated with disease progression and overall survival, AR (deficit vs non; HR = 7.24, 95% CI: 2.58-20.32; p < .001). Eight out of seventeen patients who underwent follow-up test session showed cognitive improvement, five resulted in further deterioration, and four patients remained stable. LTM, EF, and CA were the most affected functions at follow-up, while verbal learning was the most improved one in patients with cognitive improvement. CONCLUSIONS Cognitive functioning evaluation should be included among the standard clinical endpoints in the treatment of older adult neuro-oncology patients.
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Affiliation(s)
- Antonio Tanzilli
- Neuro-Oncology Unit, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy.
| | - Andrea Pace
- Neuro-Oncology Unit, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Stefano Telera
- Division of Neurosurgery, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonello Vidiri
- Division of Radiology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Mariantonia Carosi
- Division of Neuropathology, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Tatiana Koudriavtseva
- Neuro-Oncology Unit, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Riccardo Boccaletti
- Division of Neurosurgery, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Veronica Villani
- Neuro-Oncology Unit, I.R.C.C.S. Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Villani V, Tanzilli A, Telera SM, Terrenato I, Vidiri A, Fabi A, Zucchella C, Carapella CM, Marucci L, Casini B, Carosi M, Oppido PM, Pace A. Comorbidities in elderly patients with glioblastoma: a field-practice study. Future Oncol 2019; 15:841-850. [DOI: 10.2217/fon-2018-0524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Aim: This single-center study evaluated the effect of comorbidities on progression-free and overall survival in elderly patients with glioblastoma multiforme (GBM). Patients & methods: Comorbid conditions were identified in each patient with the modified version of the cumulative illness rating scale (CIRS). Results: Total of 118 patients with GBM were enrolled. An age of >75 years at diagnosis, high CIRS, comorbidity index and performance status play a predictive role on survival. Conclusion: Comorbidities play an important prognostic role in elderly patients with GBM, a factor too often neglected in clinical practice. If the prognostic role of comorbidity measured by CIRS on outcome will be confirmed, it would be interesting to add it in the algorithm for treatment choice in elderly GBM patients.
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Affiliation(s)
- Veronica Villani
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonio Tanzilli
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Stefano M Telera
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Irene Terrenato
- Biostatistic Unit, Scientific Direction, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Antonello Vidiri
- Service of Neuroradiology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Alessandra Fabi
- Division of Medical Oncology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Chiara Zucchella
- Neurology Unit, ‘Azienda Ospedaliera Universitaria Integrata’ Piazzale Aristide Stefani 1, 37126 Verona, Italy
| | - Carmine M Carapella
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Laura Marucci
- Radiotherapy Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Beatrice Casini
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Mariantonia Carosi
- Division of Neuropathology, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Piero M Oppido
- Division of Neurosurgery, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - Andrea Pace
- Neuro-Oncology Unit, ‘Regina Elena’ National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Abstract
Background Glioblastoma has in last 20 years seen the steady increase of incidence, which is most prominent in the group of older patients. These older than 70 years have significantly poorer prognosis than other patients and are considered a distinct group of glioblastoma patients. Modified prognostic factors are being used in these patients and this information is lately supplemented with the genetic and epigenetic information on tumour. The therapy is now often tailored accordingly. The aim of our study was to analyse the current treatment of the glioblastoma patients over 70 years of age to determine the impact of clinical prognostic factors. Patients and methods Among patients treated at the Institute of Oncology Ljubljana between 1997 and 2015, we found that 207 were older than 70 years. We analysed their survival, clinical prognostic factors (age, performance status) treatment modalities (extent of surgery, radiation dose, chemotherapy). Results Median survival of patients older than 70 years was 5.3 months which was statistically significant inferior to the survival of younger patients (p < 0.001). The clinical prognostic factors that influenced survival the most were performance status (p < 0.001), extent of surgical resection (p < 0.001), addition of temozolomide (p < 0.001) and addition of radiotherapy (p = 0.006). Patients receiving concomitant radiochemotherapy with temozolomide followed by adjuvant temozolomide, had same median survival as patients receiving adjuvant temozolomide after completion of radiotherapy. Conclusions The increase of the number of older patients with glioblastoma corresponds to the increase in the life expectancy but in Slovenia also to the increased availability of diagnostic procedures. Clinical prognostic markers are helpful in decision on the aggressiveness of treatment. Radiotherapy and temozolomide have the biggest impact on survival, but the radiotherapy dose seems to be of secondary importance. In selected patients, chemotherapy alone might be sufficient to achieve an optimal effect. Patients that were fitter, had more aggressive surgery, and received temozolomide fared the best. The scheduling of the temozolomide seems to have limited impact on survival as in our study, there was no difference weather patients received temozolomide concomitant with radiotherapy or after the radiotherapy. Thus far, our findings corroborate the usefulness of recursive partitioning analysis (RPA) classes in clinical decisions.
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Pretanvil JA, Salinas IQ, Piccioni DE. Glioblastoma in the elderly: treatment patterns and survival. CNS Oncol 2017; 6:19-28. [PMID: 28001088 PMCID: PMC6027939 DOI: 10.2217/cns-2016-0023] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 09/07/2016] [Indexed: 11/21/2022] Open
Abstract
AIM The optimal treatment for elderly glioblastoma patients is unclear. We conducted a retrospective review of the California Cancer Registry to examine treatment patterns and survival by age. METHODS We identified 2670 adult patients from the California Cancer Registry with glioblastoma. We compared the extent of resection, treatment type and modality. RESULTS Elderly patients had the greatest overall survival (OS) with combined surgery, radiation and chemotherapy. However, they were more likely to undergo biopsy and less likely to receive combined radiation and chemotherapy than patients <70. CONCLUSION OS was maximized in elderly patients who were able to get some surgical resection and undergo combined radiation and chemotherapy. OS survival in some elderly patients may be improved by more extensive therapy.
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Affiliation(s)
- Jean-Aine Pretanvil
- Department of Neurosciences, UCSD Moores Cancer Center, University of California San Diego, 3855 Health Science Drive, La Jolla, CA 92093-0819, USA
| | - Isaac Q Salinas
- Department of Neurosciences, UCSD Moores Cancer Center, University of California San Diego, 3855 Health Science Drive, La Jolla, CA 92093-0819, USA
| | - David E Piccioni
- Department of Neurosciences, UCSD Moores Cancer Center, University of California San Diego, 3855 Health Science Drive, La Jolla, CA 92093-0819, USA
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Wegman-Ostrosky T, Reynoso-Noverón N, Mejía-Pérez SI, Sánchez-Correa TE, Alvarez-Gómez RM, Vidal-Millán S, Cacho-Díaz B, Sánchez-Corona J, Herrera-Montalvo LA, Corona-Vázquez T. Clinical prognostic factors in adults with astrocytoma: Historic cohort. Clin Neurol Neurosurg 2016; 146:116-22. [PMID: 27208871 DOI: 10.1016/j.clineuro.2016.05.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/24/2016] [Accepted: 05/03/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To explore the clinical prognostic factors for adults affected with astrocytoma. PATIENTS AND METHODS Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated. RESULTS The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy+radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years. CONCLUSION In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n=14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.
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Affiliation(s)
- Talia Wegman-Ostrosky
- Dirección de Investigación, Instituto Nacional de Cancerologia, San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - Nancy Reynoso-Noverón
- Dirección de Investigación, Instituto Nacional de Cancerologia, San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - Sonia I Mejía-Pérez
- Subdirección de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur # 3877, CP 14269 Tlalpan, CDMX, Mexico.
| | - Thalía E Sánchez-Correa
- Subdirección de Neurocirugía, Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur # 3877, CP 14269 Tlalpan, CDMX, Mexico.
| | - Rosa María Alvarez-Gómez
- Dirección de Investigación, Instituto Nacional de Cancerologia, San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - Silvia Vidal-Millán
- Dirección de Investigación, Instituto Nacional de Cancerologia, San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - Bernardo Cacho-Díaz
- Departamento Neuro-oncologia, Instituto Nacional de Cancerologia San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - José Sánchez-Corona
- Dirección Centro de Investigaciones Biomedicas, Cetro Médico de Occidente, IMSS, Sierra mojada 800, 44340 Guadalajara, Jalisco, Mexico.
| | - Luis A Herrera-Montalvo
- Dirección de Investigación, Instituto Nacional de Cancerologia, San Fernando 22, Sección XVI, CP 14080 Tlalpan, CDMX, Mexico.
| | - Teresa Corona-Vázquez
- Laboratorio Clínico de Enfermedades Neurodegenerativas, Instituto Nacional de Neurología y Neurocirugía, Insurgentes Sur # 3877, CP 14269 Tlalpan, CDMX, Mexico.
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A novel strategy for forensic age prediction by DNA methylation and support vector regression model. Sci Rep 2015; 5:17788. [PMID: 26635134 PMCID: PMC4669521 DOI: 10.1038/srep17788] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/05/2015] [Indexed: 11/09/2022] Open
Abstract
High deviations resulting from prediction model, gender and population difference have limited age estimation application of DNA methylation markers. Here we identified 2,957 novel age-associated DNA methylation sites (P < 0.01 and R(2) > 0.5) in blood of eight pairs of Chinese Han female monozygotic twins. Among them, nine novel sites (false discovery rate < 0.01), along with three other reported sites, were further validated in 49 unrelated female volunteers with ages of 20-80 years by Sequenom Massarray. A total of 95 CpGs were covered in the PCR products and 11 of them were built the age prediction models. After comparing four different models including, multivariate linear regression, multivariate nonlinear regression, back propagation neural network and support vector regression, SVR was identified as the most robust model with the least mean absolute deviation from real chronological age (2.8 years) and an average accuracy of 4.7 years predicted by only six loci from the 11 loci, as well as an less cross-validated error compared with linear regression model. Our novel strategy provides an accurate measurement that is highly useful in estimating the individual age in forensic practice as well as in tracking the aging process in other related applications.
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