12 research outputs found
Factors associated with increased survival after surgical resection of glioblastoma in octogenarians.
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
NIMG-62USING A MULTI-COMPARTMENT DIFFUSION MODEL TO CHARACTERIZE EDEMA DIFFERENCES BETWEEN GBMS AND BRAIN METASTASES
Factors associated with increased survival after surgical resection of glioblastoma in octogenarians.
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
EGFR expression and survival.
<p>EGFR = epidermal growth factor receptor. * Denotes p < 0.05.</p
Survival curve by KPS.
<p>Legend: KPS = Karnofsky Performance Scale. * Denotes p < 0.05.</p
Survival curve by adjuvant therapy.
<p>* Denotes p < 0.05. Tx = treatment. Rad = radiation.</p
Postoperative Profiles.
<p>Legend: Values provided as median (with range) or absolute numbers with percentage. Wilcoxon Rank Sum tests were used to determine differences in overall survival between those who underwent gross total and subtotal resection, as well as survival differences in the adjuvant treatment group and length of stay parameters. NS = not significant (p > 0.05). ICU = intensive care unit. SNF = skilled nursing facility.</p><p>Postoperative Profiles.</p
Immunohistochemical staining.
<p>Legend: EGFR = epidermal growth factor receptor. IDH1 = isocitrate dehydrogenase. Ki index = Antigen Ki-67 index. EGFR (+) = positive staining for the epidermal growth factor receptor. EGFR (-) = no staining for the epidermal growth factor receptor was present. P53 (+) = presence of p53 immunohistochemical staining. P53 (wt)- wt = wild type. No immunohistochemical p53 staining was found. Total simple size for EGFR was 47 patients. Total simple size for P53 staining was 31. IDH1 staining was available in 22 patients. Ki index was available in 34 patients.</p><p>Immunohistochemical staining.</p
Presenting symptoms and tumor characteristics.
<p>Presenting symptoms and tumor characteristics.</p