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Competing risk model to determine the prognostic factors and treatment strategies for elderly patients with glioblastoma.

Abstract
The prognostic factors and optimal treatment for the elderly patient with glioblastoma (GBM) were poorly understood. This study extracted 4975 elderly patients (≥ 65 years old) with histologically confirmed GBM from Surveillance, Epidemiology and End Results (SEER) database. Firstly, Cumulative incidence function and cox proportional model were utilized to illustrate the interference of non-GBM related mortality in our cohort. Then, the Fine-Gray competing risk model was applied to determine the prognostic factors for GBM related mortality. Age ≥ 75 years old, white race, size > 5.4 cm, frontal lobe tumor, and overlapping lesion were independently associated with more GBM related death, while Gross total resection (GTR) (HR 0.87, 95%CI 0.80-0.94, P = 0.010), radiotherapy (HR 0.64, 95%CI 0.55-0.74, P < 0.001), chemotherapy (HR 0.72, 95%CI 0.59-0.90, P = 0.003), and chemoRT (HR 0.43, 95%CI 0.38-0.48, P < 0.001) were identified as independently protective factors of GBM related death. Based on this, a corresponding nomogram was conducted to predict 3-, 6- and 12-month GBM related mortality, the C-index of which were 0.763, 0.718, and 0.694 respectively. The calibration curve showed that there was a good consistency between the predicted and the actual mortality probability. Concerning treatment options, GTR followed by chemoRT is suggested as optimal treatment. Radiotherapy and chemotherapy alone also provide moderate clinical benefits.
AuthorsZhuo-Yi Liu, Song-Shan Feng, Yi-Hao Zhang, Li-Yang Zhang, Sheng-Chao Xu, Jing Li, Hui Cao, Jun Huang, Fan Fan, Li Cheng, Jun-Yi Jiang, Quan Cheng, Zhi-Xiong Liu
JournalScientific reports (Sci Rep) Vol. 11 Issue 1 Pg. 9321 (04 29 2021) ISSN: 2045-2322 [Electronic] England
PMID33927308 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
Topics
  • Aged
  • Brain Neoplasms (mortality, therapy)
  • Female
  • Glioblastoma (mortality, therapy)
  • Humans
  • Male
  • Nomograms
  • Retrospective Studies
  • Risk Assessment
  • SEER Program
  • United States (epidemiology)

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