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中国老年胶质瘤患者术前评估专家共识(2019)

中国医师协会脑胶质瘤专委会老年胶质瘤学组

中国医师协会脑胶质瘤专委会老年胶质瘤学组. 中国老年胶质瘤患者术前评估专家共识(2019)[J]. 协和医学杂志, 2019, 10(4): 326-335. doi: 10.3969/j.issn.1674-9081.2019.04.004
引用本文: 中国医师协会脑胶质瘤专委会老年胶质瘤学组. 中国老年胶质瘤患者术前评估专家共识(2019)[J]. 协和医学杂志, 2019, 10(4): 326-335. doi: 10.3969/j.issn.1674-9081.2019.04.004
Glioma Committee of the Gerontology Section of Chinese Medical Doctor Association. Expert Consensus on the Preoperative Geriatric Assessments of Elderly Patients with Glioma (2019)[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 326-335. doi: 10.3969/j.issn.1674-9081.2019.04.004
Citation: Glioma Committee of the Gerontology Section of Chinese Medical Doctor Association. Expert Consensus on the Preoperative Geriatric Assessments of Elderly Patients with Glioma (2019)[J]. Medical Journal of Peking Union Medical College Hospital, 2019, 10(4): 326-335. doi: 10.3969/j.issn.1674-9081.2019.04.004

中国老年胶质瘤患者术前评估专家共识(2019)

doi: 10.3969/j.issn.1674-9081.2019.04.004
基金项目: 

中国医学科学院医学与健康科技创新工程 2016-I2M-2-001

详细信息
    通讯作者:

    马文斌电话:010-69152530,E-mail: mawb2001@hotmail.com

  • 中图分类号: R739.41

Expert Consensus on the Preoperative Geriatric Assessments of Elderly Patients with Glioma (2019)

More Information
  • 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。
    利益冲突  无
  • 图  1  老年胶质瘤患者术前评估相关文献检索及筛查流程图

    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 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 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
    下载: 导出CSV

    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 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
    下载: 导出CSV

    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
    下载: 导出CSV
  • [1] Ostrom QT, Gittleman H, Xu J, et al. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2009-2013[J]. Neuro Oncol, 2016, 18:v1-v75. doi:  10.1093/neuonc/now207
    [2] 国家卫生健康委员会医政医管局.脑胶质瘤诊疗规范(2018年版)[J].中华神经外科杂志, 2019, 35:217-239. doi:  10.3760/cma.j.issn.1001-2346.2019.03.001
    [3] Almenawer SA, Badhiwala JH, Alhazzani W, et al. Biopsy versus partial versus gross total resection in older patients with high-grade glioma: a systematic review and meta-analysis[J]. Neuro Oncol, 2015, 17:868-881. doi:  10.1093/neuonc/nou349
    [4] Extermann M, Hurria A. Comprehensive geriatric assessment for older patients with cancer[J]. J Clin Oncol, 2007, 25:1824-1831. doi:  10.1200/JCO.2007.10.6559
    [5] Martinez R, Janka M, Soldner F, et al. Gross-total resection of malignant gliomas in elderly patients: implications in survival[J]. Zentralbl Neurochir, 2007, 68:176-181. doi:  10.1055/s-2007-985851
    [6] Vuorinen V, Hinkka S, Farkkila M, et al. Debulking or biopsy of malignant glioma in elderly people-a randomised study[J]. Acta Neurochir (Wien), 2003, 145:5-10. doi:  10.1007/s00701-002-1030-6
    [7] Gupta N, Goumnerova LC, Manley P, et al. Prospective feasibility and safety assessment of surgical biopsy for patients with newly diagnosed diffuse intrinsic pontine glioma[J]. Neuro Oncol, 2018, 20:1547-1555. doi:  10.1093/neuonc/noy070
    [8] Kellermann SG, Hamisch CA, Ruess D, et al. Stereotactic biopsy in elderly patients: risk assessment and impact on treatment decision[J]. J Neurooncol, 2017, 134:303-307. doi:  10.1007/s11060-017-2522-9
    [9] Tanaka S, Meyer FB, Buckner JC, et al. Presentation, management, and outcome of newly diagnosed glioblastoma in elderly patients[J]. J Neurosurg, 2013, 118:786-798. doi:  10.3171/2012.10.JNS112268
    [10] Mohile SG, Dale W, Somerfield MR, et al. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy: ASCO Guideline for Geriatric Oncology[J]. J Clin Oncol, 2018, 36:2326-2347. doi:  10.1200/JCO.2018.78.8687
    [11] Soubeyran P, Bellera C, Goyard J, et al. Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study[J]. PLoS One, 2014, 9:e115060. doi:  10.1371/journal.pone.0115060
    [12] Overcash JA, Beckstead J, Extermann M, et al. The abbreviated comprehensive geriatric assessment (aCGA): a retrospective analysis[J]. Crit Rev Oncol Hematol, 2005, 54:129-136. doi:  10.1016/j.critrevonc.2004.12.002
    [13] Saliba D, Elliott M, Rubenstein LZ, et al. The Vulnerable Elders Survey: a tool for identifying vulnerable older people in the community[J]. J Am Geriatr Soc, 2001, 49:1691-1699. doi:  10.1046/j.1532-5415.2001.49281.x
    [14] Kim JW, Kim SH, Lee YG, et al. Prospective Validation of The Korean Cancer Study Group Geriatric Score (KG)-7, a Novel Geriatric Screening Tool, in Older Patients with Advanced Cancer Undergoing First-line Palliative Chemotherapy[J]. Cancer Res Treat, 2019. doi: 10.4143/crt.2018.451. [Epub ahead of print].
    [15] Rowbottom L, Loucks A, Jin R, et al. Performance of the Vulnerable Elders Survey 13 screening tool in identifying cancer treatment modification after geriatric assessment in pre-treatment patients: A retrospective analysis[J]. J Geriatr Oncol, 2019, 10:229-234. doi:  10.1016/j.jgo.2018.10.018
    [16] Perry JR, Laperriere N, O'Callaghan CJ, et al. Short-Course Radiation plus Temozolomide in Elderly Patients with Glioblastoma[J]. N Engl J Med, 2017, 376:1027-1037. doi:  10.1056/NEJMoa1611977
    [17] Johnson DR, Sawyer AM, Meyers CA, et al. Early measures of cognitive function predict survival in patients with newly diagnosed glioblastoma[J]. Neuro Oncol, 2012, 14:808-816. doi:  10.1093/neuonc/nos082
    [18] Hansson L, Lithell H, Skoog I, et al. Study on COgnition and Prognosis in the Elderly (SCOPE): baseline characteristics[J]. Blood Press, 2000, 9:146-151. doi:  10.1080/080370500453483999
    [19] Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment[J]. J Am Geriatr Soc, 2005, 53:695-699. doi:  10.1111/j.1532-5415.2005.53221.x
    [20] Rambeau A, Beauplet B, Laviec H, et al. Prospective comparison of the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE) in geriatric oncology[J]. J Geriatr Oncol, 2019, 10:235-240. doi:  10.1016/j.jgo.2018.08.003
    [21] Fiorentino A, Caivano R, Chiumento C, et al. Comorbidity assessment and adjuvant radiochemotherapy in elderly affected by glioblastoma[J]. Med Oncol, 2012, 29:3467-3471. doi:  10.1007/s12032-012-0246-4
    [22] Ening G, Osterheld F, Capper D, et al. Charlson comorbidity index: an additional prognostic parameter for preoperative glioblastoma patient stratification[J]. J Cancer Res Clin Oncol, 2015, 141:1131-1137. doi:  10.1007/s00432-014-1907-9
    [23] Villani V, Tanzilli A, Telera SM, et al. Comorbidities in elderly patients with glioblastoma: a field-practice study[J]. Future Oncol, 2019, 15:841-850. doi:  10.2217/fon-2018-0524
    [24] Cloney M, D'Amico R, Lebovic J, et al. Frailty in Geriatric Glioblastoma Patients: A Predictor of Operative Morbidity and Outcome [J]. World Neurosurg, 2016, 89:362-367. doi:  10.1016/j.wneu.2015.12.096
    [25] Basic D, Shanley C. Frailty in an older inpatient population: using the clinical frailty scale to predict patient outcomes[J]. J Aging Health, 2015, 27:670-685. doi:  10.1177/0898264314558202
    [26] Peters KB, West MJ, Hornsby WE, et al. Impact of health-related quality of life and fatigue on survival of recurrent high-grade glioma patients[J]. J Neurooncol, 2014, 120:499-506. doi:  10.1007/s11060-014-1574-3
    [27] Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology[J]. J Natl Cancer Inst, 1993, 85:365-376. doi:  10.1093/jnci/85.5.365
    [28] Aapro M, Extermann M, Repetto L. Evaluation of the elderly with cancer[J]. Ann Oncol, 2000, 11 Suppl 3:223-229.
    [29] Jager-Wittenaar H, Dijkstra PU, Vissink A, et al. Malnutrition in patients treated for oral or oropharyngeal cancer—prevalence and relationship with oral symptoms: an explorative study[J]. Support Care Cancer, 2011, 19:1675-1683. doi:  10.1007/s00520-010-1001-z
    [30] Gielda BT, Mehta P, Khan A, et al. Weight gain in advanced non-small-cell lung cancer patients during treatment with split-course concurrent chemoradiotherapy is associated with superior survival[J]. Int J Radiat Oncol Biol Phys, 2011, 81:985-991. doi:  10.1016/j.ijrobp.2010.06.059
    [31] 李璞, 赵理.南阳市敬老院230例老人营养状况调查[J].中国老年学杂志, 2004, 24:747-748. doi:  10.3969/j.issn.1005-9202.2004.08.036
    [32] 周丽平, 孙建萍, 杨支兰, 等.养老机构老年人营养管理研究进展[J].中国老年学杂志, 2016, 36:753-755. doi:  10.3969/j.issn.1005-9202.2016.03.106
    [33] Rubenstein LZ, Harker JO, Salva A, et al. Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment (MNA-SF) [J]. J Gerontol A Biol Sci Med Sci, 2001, 56:M366-M372. doi:  10.1093/gerona/56.6.M366
    [34] Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment[J]. Clin Geriatr Med, 2002, 18:737-757. doi:  10.1016/S0749-0690(02)00059-9
    [35] Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assess-ment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) [J]. Eur Heart J, 2014, 35:2383-2431. doi:  10.1093/eurheartj/ehu282
    [36] Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines[J]. J Am Coll Cardiol, 2014, 64:e77-e137. doi:  10.1016/j.jacc.2014.07.944
    [37] 朱鸣雷, 黄宇光, 刘晓红, 等.老年患者围手术期管理北京协和医院专家共识[J].协和医学杂志, 2018, 9:36-41. doi:  10.3969/j.issn.1674-9081.2018.01.008
    [38] Kaya T, Sipahi S, Karacaer C, et al. Evaluation of nutritional status with different methods in geriatric hemodialysis patients: impact of gender[J]. Int Urol Nephrol, 2014, 46:2385-2391. doi:  10.1007/s11255-014-0776-0
    [39] Lin MY, Liu WY, Tolan AM, et al. Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer[J]. Am Surg, 2011, 77:1286-1289. https://www.ncbi.nlm.nih.gov/pubmed/22127071
    [40] Fujii T, Sutoh T, Morita H, et al. Serum albumin is superior to prealbumin for predicting short-term recurrence in patients with operable colorectal cancer[J]. Nutr Cancer, 2012, 64:1169-1173. doi:  10.1080/01635581.2012.718034
    [41] Han S, Li Z, Master LM, et al. Exogenous IGFBP-2 promotes proliferation, invasion, and chemoresistance to temozolomide in glioma cells via the integrin beta1-ERK pathway[J]. Br J Cancer, 2014, 111:1400-1409. doi:  10.1038/bjc.2014.435
    [42] Borg N, Guilfoyle MR, Greenberg DC, et al. Serum albumin and survival in glioblastoma multiforme[J]. J Neurooncol, 2011, 105:77-81. doi:  10.1007/s11060-011-0562-0
    [43] Schwartzbaum JA, Lal P, Evanoff W, et al. Presurgical serum albumin levels predict survival time from glioblastoma multiforme[J]. J Neurooncol, 1999, 43:35-41. doi:  10.1023/A:1006269413998
    [44] Perisanidis C, Psyrri A, Cohen EE, et al. Prognostic role of pretreatment plasma fibrinogen in patients with solid tumors: A systematic review and meta-analysis[J]. Cancer Treat Rev, 2015, 41:960-970. doi:  10.1016/j.ctrv.2015.10.002
    [45] Zhao J, Zhao M, Jin B, et al. Tumor response and survival in patients with advanced non-small-cell lung cancer: the predictive value of chemotherapy-induced changes in fibrinogen[J]. BMC Cancer, 2012, 12:330. doi:  10.1186/1471-2407-12-330
    [46] Pichler M, Hutterer GC, Stojakovic T, et al. High plasma fibrinogen level represents an independent negative prognostic factor regarding cancer-specific, metastasis-free, as well as overall survival in a European cohort of non-metastatic renal cell carcinoma patients[J]. Br J Cancer, 2013, 109:1123-1129. doi:  10.1038/bjc.2013.443
    [47] Wen J, Yang Y, Ye F, et al. The preoperative plasma fibrinogen level is an independent prognostic factor for overall survival of breast cancer patients who underwent surgical treatment[J]. Breast, 2015, 24:745-750. doi:  10.1016/j.breast.2015.09.007
    [48] Matsuda S, Takeuchi H, Kawakubo H, et al. Cumulative prognostic scores based on plasma fibrinogen and serum albumin levels in esophageal cancer patients treated with transthoracic esophagectomy: comparison with the Glasgow prognostic score[J]. Ann Surg Oncol, 2015, 22:302-310. doi:  10.1245/s10434-014-3857-5
    [49] He ZQ, Duan H, Ke C, et al. Evaluation of cumulative prognostic score based on pretreatment plasma fibrinogen and serum albumin levels in patients with newly diagnosed high-grade gliomas[J]. Oncotarget, 2017, 8:49605-49614. doi:  10.18632/oncotarget.17849
    [50] Han LH, Jia YB, Song QX, et al. Prognostic significance of preoperative lymphocyte-monocyte ratio in patients with resectable esophageal squamous cell carcinoma[J]. Asian Pac J Cancer Prev, 2015, 16:2245-2250. doi:  10.7314/APJCP.2015.16.6.2245
    [51] Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer[J]. Crit Rev Oncol Hematol, 2013, 88:218-230. doi:  10.1016/j.critrevonc.2013.03.010
    [52] Zitvogel L, Tesniere A, Kroemer G. Cancer despite immunosurveillance: immunoselection and immunosubversion[J]. Nat Rev Immunol, 2006, 6:715-727. doi:  10.1038/nri1936
    [53] Inouye SK, Studenski S, Tinetti ME, et al. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept[J]. J Am Geriatr Soc, 2007, 55:780-791. doi:  10.1111/j.1532-5415.2007.01156.x
    [54] Kane RL, Shamliyan T, Talley K, et al. The association between geriatric syndromes and survival[J]. J Am Geriatr Soc, 2012, 60:896-904. doi:  10.1111/j.1532-5415.2012.03942.x
    [55] Vallet-Regi M, Manzano M, Rodriguez-Manas L, et al. Management of Cancer in the Older Age Person: An Approach to Complex Medical Decisions[J]. Oncologist, 2017, 22:335-342. doi:  10.1634/theoncologist.2016-0276
    [56] Svendsboe E, Terum T, Testad I, et al. Caregiver burden in family carers of people with dementia with Lewy bodies and Alzheimer's disease[J]. Int J Geriatr Psychiatry, 2016, 31:1075-1083. doi:  10.1002/gps.4433
    [57] Balducci L, Extermann M. Management of cancer in the older person: a practical approach[J]. Oncologist, 2000, 5:224-237. doi:  10.1634/theoncologist.5-3-224
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  • 收稿日期:  2019-06-18
  • 刊出日期:  2019-07-30

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