LAUSR

BACKGROUND Elderly patients with glioblastoma (GBM) have worse prognosis compared to younger patients. The study aimed to identify patient, treatment, and imaging features including measures of sarcopenia associated with worse survival and 90-day postoperative mortality in elderly patients with GBM. METHODS A single-center retrospective study was conducted of patients age≥79 at surgery who underwent biopsy or resection of a WHO Grade IV GBM at the time of initial diagnosis. Imaging features of sarcopenia were collected including masseter and temporalis muscle diameter. Multivariate analyses were performed to identify factors associated with survival and 30-day complications. RESULTS The cohort consisted of 110 patients with a mean age of 82.8 at surgery and a median preoperative KPS of 80. The majority of patients underwent a surgical resection (66.4%) while a minority underwent biopsy (33.6%). Adjuvant chemo- and/or radiation therapy were used in 72.5% of the cohort. On multivariate analysis, age (HR7.97; 95%CI 1.63-36.3), adjuvant therapy (XRT or TMZ vs None: HR0.12, 95%CI 0.05-0.3; XRT and TMZ vs None: HR0.05, 95%CI 0.02-0.14), surgical resection (HR0.46, 95%CI 0.24-0.9), multifocality (HR2.7, 95%CI 1.14-6.4), and masseter diameter (HR0.12; 95%CI 0.02-0.78) were associated with survival. Masseter diameter was the only factor associated with 90-day mortality after surgical resection (p=0.044). CONCLUSIONS GBM patients over the age of 79 have acceptable outcomes when undergoing resection followed by adjuvant chemotherapy and radiation therapy. In addition to treatment factors that predict survival, decreased masseter diameter on preoperative imaging, a marker of sarcopenia, is associated with shorter overall survival and 90-day mortality after performing a surgical resection.