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Expert Consensus on the Preoperative Geriatric Assessments of Elderly Patients with Glioma (2019)
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摘要: 胶质瘤是成年人中最常见的原发性脑肿瘤，其中以胶质母细胞瘤(glioblastoma，GBM)恶性程度最高。目前针对胶质瘤患者的治疗方式主要包括手术切除、放疗和化疗，而GBM的治疗策略，特别是老年GBM患者的治疗策略，尤其是手术方式，常因其自身特点而产生差异。术前系统而全面的评估有助于总结老年GBM的临床特点及相应诊疗方案，为临床医生提供更全面的患者信息，以更加准确判断老年患者对手术的耐受程度以及预测患者预后。本专家共识在对最新研究证据进行系统回顾的基础上，将目前已广泛应用的胶质瘤术前评估项目及评估工具进行总结，初步建立中国老年胶质瘤患者术前评估体系。Abstract: Glioma is the most common primary brain tumor in adults, among which glioblastoma (GBM) is the most malignant. At present, the therapeutic regimen for patients with glioma mainly includes surgery, radiotherapy, and chemotherapy. However, the treatment strategy for elderly patients with GBM often varies because of their characteristics. A systematic and comprehensive assessment before the operation will be helpful to summarize clinical characteristics of elderly patients with GBM, and can provide clinicians with more comprehensive clinical information in order to evaluate the patient's tolerance to surgery and predict the prognosis. Based on a systematic review of the latest research, this expert consensus summarizes the most widely used and studied tools of preoperative assessment of glioma, and initially establishes a preoperative evaluation system for elderly patients with glioma in China.
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Key words:
- glioma /
- preoperative assessment /
- geriatric
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表 1 老年胶质瘤患者手术治疗方案相关文献
作者 发表时间 平均年龄(岁) 性别(男/女, n) 干预措施 结果 随访时间(年) 研究类型 试验组 对照组 Gupta等[7] 2018年 6.3 23/27 活检术 无 50例弥漫内生性脑干胶质瘤患者中，46例成功获得活检组织并指导进一步诊治 随访至死亡 单臂临床研究 Kellermann等[8] 2017年 74 129/101 立体定向活检术 无 239例老年胶质瘤患者中230例接受了立体定向活检术，其中222例成功取得组织学诊断并有171例接受了后续辅助治疗 1 回顾性研究 Tanaka等[9] 2013年 74.1 61/44 立体定向活检术 常规外科手术 接受立体定向活检术的患者术后出血风险较常规外科手术高 5 回顾性研究 
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表 2 老年胶质瘤患者术前评估相关文献
作者 发表时间 平均年龄(岁) 性别(男/女, n) 干预措施 结果 平均随访时间(年) 研究类型 评估项目 试验组 对照组 Johnson等[17] 2012年 53.9 55/36 WAIS-R, WAIS-Ⅲ, HVLT-R量表 无 认知功能中的执行力与注意力均与胶质母细胞瘤患者的预后有关 9 回顾性研究 认知功能 Rambeau等[20] 2018年 78 25/41 MMSE量表 MoCA量表 MoCA量表比MMSE量表在评估认知功能方面更加精确 1 临床对照研究 认知功能 Fiorentino等[21] 2012年 72 17/18 - - 对合并症的评估也是对老年胶质母细胞瘤患者预后预测十分有效的工具 6 单臂临床研究 合并症 Ening等[22] 2015年 62 117/116 - - 年龄越大、KPS越低、CCI越高，则难治性胶质母细胞瘤患者的总生存期或肿瘤无进展生存期越短 5 回顾性研究 合并症 Villani等[23] 2019年 73 70/48 - - CIRS合并症指数得分越高，老年胶质母细胞瘤患者手术、放/化疗或单纯放疗的预后越差 1 前瞻性队列研究 合并症 Cloney等[24] 2015年 NA NA - - 虚弱的老年胶质母细胞瘤患者更不倾向于接受手术治疗，其卧床时间较长，且术后并发症发生率较高 12 回顾性研究 虚弱 Peters等[26] 2014年 50 161/76 - - 疲惫独立影响复发高级别胶质瘤患者的预后，疲惫感越强则预后越差；生活质量并非预后的独立预测因素 2 前瞻性队列研究 疲惫与生活质量 Borg等[42] 2011年 60.1 419/266 - - 术前低蛋白血症患者较正常者术后生存期短 10 回顾性研究 实验室检验 He等[49] 2017年 44 197/129 - - 术前高纤维蛋白原和低血胆红素的新诊断高级别患者肿瘤进展和死亡风险更大 2 单臂临床研究 实验室检验 -：未分组评估；WAIS-R：Wechsler成人智力量表(修订版); HVLT-R:霍普金斯词语学习测验(修订版); MMSE：简易精神状态检查; MoCA：蒙特利尔认知评估; KPS：卡式评分; CCI：查尔森合并症指数；CIRS：累积疾病评分量表
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表 3 老年胶质瘤患者术前评估筛查方法相关文献
作者 发表时间 平均年龄(岁) 性别(男/女，n) 测量方法/量表 结果 研究类型 评估项目 Kane等[54] 2012年 NA NA 通过8项老年综合征指标(合并症、认知功能障碍、虚弱、残疾、营养不良、内分泌紊乱、慢性炎症等)评估 对老年综合征的评估对年龄稍小老龄患者意义更大；对年龄较大老龄患者意义不大 系统综述 老年综合征 Soubeyran等[11] 2014年 78 434/1001 用G8量表和老年人受伤情况调查(第13版)量表对老年癌症患者进行多维度老年评估，包括特异度、敏感度、阳性预测值、阴性预测值，1年生存期预测等 G8量表的敏感度较VES-13高，但特异度则比VES-13低。G8量表评分可以独立预测老年癌症患者的1年生存期 前瞻性队列研究 多维度老年学评估 Svendsboe等[56] 2015年 74.9 72/114 RSS，认知功能(MMSE、CDR-SOB)，精神心理状态(NPI、MADRS、UPDRS)，其他变量因素(CIRS、RDRS-2) 照护者在阿尔茨海默病和路易氏痴呆患者的发病初期，可能会有轻到中度的照护者负担问题，同样也会有精神问题的可能 横断面研究 照护提供者 RSS：照护者负担量表；MMSE：简易精神状态量表；CDR-SOB：临床痴呆评定量表；NPI：神经精神症状问卷；MADRS：蒙哥马利和阿斯伯格抑郁症等级量表；UPDRS：帕金森分级量表；CIRS：累积疾病评分量表；RDRS-2：快速残疾评定量表
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