EPID-14OUTCOMES IN ELDERLY PATIENTS WITH HIGH GRADE GLIOMAS

Abstract

BACKGROUND: High Grade Gliomas (HGG, grade 3 or grade 4 gliomas) are common malignant primary brain tumors and a large number of cases occur in patients aged >65 years. However, there is limited data on specific prognostic factors and outcomes in this population. METHODS: After IRB approval, the Cleveland Clinic Brain Tumor and Neuro-Oncology Center's database was used to identify patients > 65 years of age with HGG diagnosed from 2007-2014. Multivariate analysis was conducted using a Cox proportional hazards model and stepwise selection algorithm using p = .10 and p = .05 as criteria for entry and retention to identify independent predictors of survival from diagnosis. RESULTS: 193 patients were included in the analysis (61% male). Median age at diagnosis was 73 years (range 66-94). At presentation, 45% had Karnofsky performance status (KPS) > 80; 34% had KPS < 60. 85% of patients were diagnosed with glioblastoma, 10% anaplastic astrocytoma, 3% anaplastic oligodendroglioma, 2% anaplastic mixed glioma. 22% had multifocal disease. Ki-67 was seen in a median of 25% of tumor cells (range 3-100); 45% of tumors (72/161) had abnormal EGFR expression; p53 expression was 0-10% in 46% (72/156). 34% had total or near total resections, 20% subtotal resections, 44% biopsy. 30% received no upfront treatment, 21% radiation only, and 49% chemotherapy and radiation. 52% had died at time of analysis. Median overall survival was 9.6 months (95% C.I. 7.3-12.2). 1- and 2-year survival rates were 42% + 4% and 24% + 4%, respectively. On multivariable analysis, age (< 75 vs >75, p = .03), performance status (KPS >80 vs 70 vs 50-60 vs <50, p < .0001) and multifocal disease (no vs yes, p = .02) were independently associated with overall survival. CONCLUSIONS: Overall survival in elderly patients with HGG is dismal. Younger age, better performance status, and absence of multifocal disease were associated with improved survival.