Background:Glioblastoma (GB) carries a dismal prognosis, with survival outcomes particularly poor in older patients. With the fastest-growing global demographic being those aged over 65, the incidence of GB is expected to rise.Objective:To evaluate predictors of survival in patients aged ≥70 years with histologically confirmed GB, focusing on surgical resection, adjuvant therapy, and comorbidities.Methods:A retrospective review was performed of all patients aged ≥70 undergoing index surgery for GB between January 2021 and March 2025 at a single tertiary neurosurgical centre. Demographics, pre-operative fitness scores (Karnofsky Performance Status [KPS]., Charlson Comorbidity Index [CCI].), tumour characteristics, extent of resection, adjuvant treatment, and survival were analysed. Tumour volume was estimated using the ABC/2 method. Survival outcomes were assessed using Kaplan–Meier curves and multivariable Cox proportional hazards regression.Results:A total of 124 patients aged ≥70 years (median 74 years, range 70–86) were included. Median overall survival was 8 months (IQR 4–15). On multivariable analysis, adjuvant chemoradiotherapy (HR = 0.30, 95% CI 0.17–0.52;p< 0.001) and gross total resection (GTR) (HR = 0.41, 95% CI 0.20–0.86;p= 0.019) were independently associated with improved survival. Smoking history was associated with increased hazard of death (HR = 2.02, 95% CI 1.07–3.81;p= 0.029), an effect robust to multiple sensitivity analyses. No significant associations were found for age, pre-operative KPS, comorbidity index, tumour volume, or methylation status (allp> 0.10). Tests for non-proportional hazards indicated that the survival benefit of adjuvant therapy diminished over time (interactionp= 0.0002), with early post-operative benefit (HR ≈ 0.35 at 1 month) that attenuated towards unity by 6–12 months. The effects of GTR and smoking were time-invariant. RMST analysis suggested a modest, non-significant absolute survival advantage of GTR over STR (mean difference = 2.0 months at 18 months;p= 0.11). After exclusion of early post-operative deaths (<6 weeks), adjuvant therapy (HR = 0.34;p< 0.001) and GTR (HR = 0.33;p= 0.005) remained independent predictors of improved survival.Conclusions:Among patients aged ≥70 years with glioblastoma, adjuvant therapy and extent of resection remain key independent predictors of survival, while smoking is associated with poorer outcomes. The survival benefit of adjuvant chemoradiotherapy is strongest in the early post-operative period and diminishes over time, underscoring the importance of early multidisciplinary intervention. These findings highlight that aggressive multimodal treatment may confer survival advantage even in older patients.
**背景：** 胶质母细胞瘤（GB）预后极差，老年患者的生存结局尤为不佳。随着全球65岁以上人口这一增长最快的群体不断扩大，GB的发病率预计将上升。 **目的：** 评估年龄≥70岁、经组织学确诊的GB患者的生存预测因素，重点关注手术切除范围、辅助治疗及合并症。 **方法：** 回顾性分析2021年1月至2025年3月期间，在一家三级神经外科中心接受初次手术的所有年龄≥70岁的GB患者。分析内容包括人口统计学特征、术前体能评分（卡氏功能状态评分[KPS]、查尔森合并症指数[CCI]）、肿瘤特征、切除范围、辅助治疗及生存情况。肿瘤体积采用ABC/2法估算。生存结局使用Kaplan-Meier曲线和多变量Cox比例风险回归进行评估。 **结果：** 共纳入124名年龄≥70岁的患者（中位年龄74岁，范围70-86岁）。中位总生存期为8个月（四分位距4-15）。多变量分析显示，辅助放化疗（HR = 0.30，95% CI 0.17–0.52；p < 0.001）和肿瘤全切除（GTR）（HR = 0.41，95% CI 0.20–0.86；p = 0.019）与生存改善独立相关。吸烟史与死亡风险增加相关（HR = 2.02，95% CI 1.07–3.81；p = 0.029），该效应在多项敏感性分析中保持稳健。年龄、术前KPS、合并症指数、肿瘤体积或甲基化状态均未发现显著关联（所有p > 0.10）。非比例风险检验表明，辅助治疗的生存获益随时间推移而减弱（交互作用p = 0.0002），术后早期获益明显（1个月时HR ≈ 0.35），至6-12个月时减弱至无差异。GTR和吸烟的效应不随时间变化。限制性平均生存时间（RMST）分析提示，与次全切除（STR）相比，GTR带来的绝对生存优势有限且不显著（18个月时平均差异 = 2.0个月；p = 0.11）。排除术后早期死亡（<6周）病例后，辅助治疗（HR = 0.34；p < 0.001）和GTR（HR = 0.33；p = 0.005）仍然是生存改善的独立预测因素。 **结论：** 在年龄≥70岁的胶质母细胞瘤患者中，辅助治疗和手术切除范围仍是关键的独立生存预测因素，而吸烟与较差的预后相关。辅助放化疗的生存获益在术后早期最强，并随时间推移而减弱，这强调了早期多学科干预的重要性。这些发现表明，即使在老年患者中，积极的综合治疗也可能带来生存获益。
肿瘤(癌症)患者之家