Shervin Taslimi , Susan Brogly , Timothy P. Hanna , Jonas Shellenberger , Marlo Whitehead , Ryan Alkins
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引用次数: 0
Abstract
Objective
Grade 4 glioma is the most common and fatal primary malignant brain tumor in adults. We sought to describe the evolution of care and survival of patients with glioblastoma in a single-payer Canadian provincial health care system over a 24-year period.
Methods
Adult patients >18 years old with pathologically or clinically diagnosed glioblastoma (based on fourth or earlier edition of World Health Organization classification) in Ontario between 1994 and 2018 were identified and followed until death or study end point of 2 years through provincial administrative health data. Patient characteristics, type of treatment, survival, and time spent in the hospital were compared across time periods, age groups, and centers.
Results
We included 9487 patients with glioblastoma treated from 1994 to 2018. Median survival and 2-year survival rate improved over the study period from 6.4 to 9.4 months and 10% to 18%, respectively. Older age was associated with shorter survival (median survival of 12 months at 65–74 years vs. 3 months at > 85 years), less aggressive therapy, and a higher proportion of remaining lifetime spent in the hospital (more than one third of patients >75 years spend ≥50% their remaining survival in hospital). Time in the hospital decreased by 8.9 days (95% confidence interval 8.53–9.25) over the study period. Significant heterogeneity exists in patient management and outcome between regional treatment centers.
Conclusions
The real-world prognosis for grade 4 glioma remains poor. However, an increased proportion of patients receiving maximal therapy is associated with a small but meaningful improvement in survival and decreased time in the hospital for all but the oldest patients.
期刊介绍:
World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review.
The journal''s mission is to:
-To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care.
-To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide.
-To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients.
Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS