在胶质母细胞瘤前期治疗中使用靶向治疗和免疫治疗的全国趋势

Richard J White, S. Abel, S. Hasan, V. Verma, T. Ranjan, S. Karlovits, Pittsburgh, Pa
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摘要

胶质母细胞瘤(GBM)预后极差。目前的治疗标准包括积极的多模式方法,包括手术切除和辅助放化疗。尽管采用了这种方法,但总体生存率仍然很低,治疗方法也在不断发展。鉴于免疫疗法在其他疾病部位的成功,在GBM管理中实施可能会改善结果。我们进行了这项回顾性国家癌症数据库(NCDB)研究,分析了2004-2015年GBM免疫治疗的治疗趋势和结果,并查询了2004-2015年诊断为GBM的患者,排除了未经手术、颅外放疗或化疗治疗的患者以及失去随访的患者。在该研究的39,317例符合条件的患者中,511例接受了免疫治疗,38,806例未接受免疫治疗。所有患者的中位总生存期为15个月,2年和5年生存率分别为29%和8%。影响免疫治疗提供的积极因素包括年龄较小、收入较高、设施位于大都市、距离治疗设施较远、在学术机构接受治疗、2007年至2009年以外的治疗以及高加索人种。倾向匹配分析显示,免疫治疗组和非免疫治疗组的生存期分别为18个月和17个月(p=0.15)。较高的合并症、较低的收入和男性性别预测生存率较差。NCDB分析的结果显示,在GBM的治疗中,免疫疗法的使用先减少后增加。倾向匹配分析并未显示总体生存获益。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
National Trends in the Use of Targeted Therapy and Immunotherapy in the Up Front Management of Glioblastoma
Glioblastoma (GBM) carries an abysmal prognosis. Current standard of care involves an aggressive multimodality approach including surgical resection followed by adjuvant chemoradiation. Despite this approach, overall survival remains poor and treatment approaches continue to evolve. Given the successes of immunotherapy in other disease sites, implementation in GBM management may improve outcomes. We conducted this retrospective National Cancer Database (NCDB) study to analyze treatment trends and outcomes from 2004-2015 regarding immunotherapy for GBM and queried for patients diagnosed between 2004-2015 with GBM and excluded patients treated without surgery, extracranial radiation, or chemotherapy as well as those lost to follow up. Of the 39,317 eligible patients in this study, 511 were treated with immunotherapy and 38,806 lack thereof. Median overall survival for all patients was 15 months with a 2 and 5 year survival rate of 29% and 8%, respectively. Factors positively influencing delivery of immunotherapy included younger age, higher income, facility location in a metropolitan location, greater distance to the treatment facility, treatment at an academic facility, treatment outside of the years 2007 to 2009, and Caucasian race. On propensity matched analysis, survival was 18 months and 17 months with and without immunotherapy, respectively (p=0.15). Higher comorbidity, lower income, and male gender predicted for worse survival. The results of the NCDB analysis showed an initial decrease and then increase in the use of immunotherapy in the management of GBM. Propensity-matched analyses did not show an overall survival benefit.
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