Validation of the Comprehensive Geriatric Assessment as a Predictor of Mortality in Elderly Glioblastoma Patients

Abstract

Background: Treatment of elderly glioblastoma patients (EGP) is a challenge in neuro-oncology. The comprehensive geriatric assessment (CGA) is currently used to assess geriatric oncological patients with other types of tumors. We performed a large retrospective study to analyze its predictive role in EGP. Methods: Patients aged ≥65 years with histologically confirmed diagnosis of glioblastoma were enrolled. CGA included the following tests: the Cumulative Illness Rating Scale-Comorbidity and Severity Index, Activities of Daily Living, Instrumental Activities of Daily Living, the Mini Mental State Examination, and the Geriatric Depression Scale. Based on CGA results, each patient was categorized as fit, vulnerable, or frail. Results: We enrolled 113 patients. According to the CGA scores, 35% of patients were categorized as “fit”, 30% as “vulnerable”, and 35% as “frail” patients. Median overall survival was 16.5, 12.1, and 10.3 months in fit, vulnerable, and frail patients (p = 0.1), respectively. On multivariate analysis, the CGA score resulted an independent predictor of survival; indeed, vulnerable and frail patients had a hazard ratio of 1.5 and 2.2, respectively, compared to fit patients (p = 0.04). No association between CGA and progression-free survival (PFS) was demonstrated. Conclusions: The CGA score proved to be a significant predictor of mortality in EGP, and it could be a useful treatment decision tool.

Update on the management of elderly patients with glioblastoma: a narrative review

“…These assessment tools are not specifically tailored for geriatric populations and do not generally differentiate tumour-related causes from other agerelated causes of impairment. The Comprehensive Geriatric Assessment (CGA), was recently validated as a predictor of mortality in elderly patients with glioblastoma (28) and involves evaluation of neuro-cognitive, functional, nutritional and psychosocial factors; however, the CGA is both time-and resource-intensive and requires training to be properly administered. In a retrospective study of 113 elderly patients with glioblastoma intended to validate the CGA, a large number of patients were medically vulnerable; with a prevalence of frailty of 35%.…”

Guiding Treatment Choices for Elderly Patients with Glioblastoma by a Comprehensive Geriatric Assessment

“…Also, in neuro-oncology, there is now at least one trial using a geriatric screening tool in the enrollment phase for elderly patients. Lombardi et al reported a retrospective analysis of a single-center study administering CGA to patients with newly diagnosed GBM and its validation as a predictor of mortality [ 51 ••]. This study included 113 patients aged 65 to 84 years (median 72 years).…”

The need for geriatric scales in glioblastoma

“…To date, unfortunately, none of the trials conducted in elderly glioblastoma patients have included geriatric scales like those that are already being applied in the treatment of other cancers. Nevertheless, a recent retrospective study found significant differences in OS when elderly glioblastoma patients were stratified according to a geriatric scale and classified as fit, vulnerable, or frail [ 8 ]. The scales used for other tumors would need to be readjusted for brain tumors and include variables related to neurological function, but once readjusted, they would certainly be useful in determining the best therapeutic option for these patients – not only as regards post-operative treatment but also when deciding on the first neurosurgical approach.…”