Andrea Bianconi, Roberto Presta, Pietro La Cava, Raffaele De Marco, Pietro Zeppa, Paola Lacroce, Margherita Castaldo, Francesco Bruno, Alessia Pellerino, Roberta Rudà, Antonio Melcarne, Diego Garbossa, Mario Bo, Fabio Cofano
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All consecutive patients aged ≥ 75 years newly diagnosed with HGG were included, regardless of whether they underwent surgical resection. Clinical, radiological, histological and molecular data were collected.Variables potentially available at the time of diagnosis were considered to develop a multivariable logistic regression predictive model, with 12-months overall survival as the dependent variable. 102 patients aged 75 years or older received a new diagnosis of high-grade glioma, of whom 68 underwent surgical resection. Patients undergoing surgery were slightly younger (76.9 vs 79.0 years, p = 0.007) and had better performance status (median KPS 80 vs 70). Most tumors undergoing surgery were localized in cortical or subcortical non-motor areas (p < 0.001) and less frequently deep-seated (p = 0.023) or multifocal (p < 0.001). A predictive model, the DAK-75 score, was developed: the AUROC of the final model was 0.822 (95% CI 0.741-0.902). 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引用次数: 0
摘要
高级别胶质瘤是成人中最常见的神经肿瘤疾病,其发病率随年龄增长而增加,在第七个十年达到高峰。本文旨在通过确定新确诊的高级别胶质瘤患者(年龄≥ 75 岁)术前 12 个月死亡率的预测因素,探讨如何选择患者进行手术切除。本文将提出一个预后评分,以指导基于预期生存期的手术决策。该研究在意大利都灵的 "Città della Salute e della Scienza-Molinette "大学医院进行。研究对象包括所有年龄≥75岁的连续性新确诊 HGG 患者,无论他们是否接受了手术切除。研究人员考虑了诊断时可能存在的变量,建立了一个多变量逻辑回归预测模型,以12个月的总生存期为因变量。102名年龄在75岁或以上的患者被确诊为高级别胶质瘤,其中68人接受了手术切除。接受手术的患者年龄略低(76.9 岁对 79.0 岁,P = 0.007),表现状态较好(KPS 中位数 80 对 70)。大多数接受手术的肿瘤位于皮质或皮质下非运动区(P 8)。评分越高,手术患者越少,一年死亡率越高(92.2% vs 47.1%,P = 0.007)。
A novel scoring system proposal to guide surgical treatment indications for high grade gliomas in elderly patients: DAK-75.
High-grade gliomas are the most prevalent neurooncological desease in adults, their incidence increases with age, peaking in the seventh decade. This paper aims to address how to select patients for surgical resection by identifying pre-surgical predictors of 12-month mortality in newly diagnosed HGG patients aged ≥ 75 years. A prognostic score will be proposed to guide surgical decisions based on expected survival. Retrospective observational single-center cohort study was carried out at the "Città della Salute e della Scienza-Molinette" University Hospital in Turin, Italy. All consecutive patients aged ≥ 75 years newly diagnosed with HGG were included, regardless of whether they underwent surgical resection. Clinical, radiological, histological and molecular data were collected.Variables potentially available at the time of diagnosis were considered to develop a multivariable logistic regression predictive model, with 12-months overall survival as the dependent variable. 102 patients aged 75 years or older received a new diagnosis of high-grade glioma, of whom 68 underwent surgical resection. Patients undergoing surgery were slightly younger (76.9 vs 79.0 years, p = 0.007) and had better performance status (median KPS 80 vs 70). Most tumors undergoing surgery were localized in cortical or subcortical non-motor areas (p < 0.001) and less frequently deep-seated (p = 0.023) or multifocal (p < 0.001). A predictive model, the DAK-75 score, was developed: the AUROC of the final model was 0.822 (95% CI 0.741-0.902). The score includes clinical presentation, tumor location, and KPS, ranging from 0 to 20, categorizing risk scores into low-risk and high-risk groups (< or > 8). Higher scores corresponded to fewer surgical patients and higher one-year mortality rates (92.2% vs 47.1%, p < 0.001). DAK-75 score may represent a valuable tool in the decision-making process for neurosurgical intervention in elderly patients diagnosed with HGG. Further studies are needed to externally and prospectively validate the scoring system.
期刊介绍:
The goal of Neurosurgical Review is to provide a forum for comprehensive reviews on current issues in neurosurgery. Each issue contains up to three reviews, reflecting all important aspects of one topic (a disease or a surgical approach). Comments by a panel of experts within the same issue complete the topic. By providing comprehensive coverage of one topic per issue, Neurosurgical Review combines the topicality of professional journals with the indepth treatment of a monograph. Original papers of high quality are also welcome.