Age is not enough: Clinical and therapeutic predictors of survival in elderly patients with de novo glioblastoma

Background: This study aims to analyze survival outcomes in patients over 65 years old with a de novo diagnosis of glioblastoma and to identify factors that impact survival to guide management decisions in this population. Methods: A retrospective single-center cohort study included all patients aged ≥65 years with a de novo histological diagnosis of isocitrate dehydrogenase (IDH)-wildtype glioblastoma treated in our hospital between 2017 and 2024. Patients with incomplete information or loss to follow-up were excluded. Kaplan-Meier curves were used for overall survival analysis. Risk factors were assessed by the Cox proportional hazards regression analyses. Results: One hundred and fourteen patients were selected with a mean age of 72.5 years old and male preponderance (58/114; 50.9%). A total of 44.7% underwent biopsy only. As far as 17.8% of the patients completed the Stupp protocol. After univariable analysis, a multivariable Cox regression analysis identified the following independent predictors of survival: single lesions at diagnosis, postoperative Karnofsky performance status, lower residual tumor volume, administration of adjuvant therapy according to the Stupp protocol, and administration of a complete radiotherapy schedule. The molecular pattern and the Charlson comorbidity index score were not significantly associated with survival. Age was not identified as an independent survival factor after adjustment by other variables. Conclusions: Aggressive treatment is also the standard of care for older patients with glioblastoma. Maximal resection followed by the Stupp protocol in patients with a good functional performance predicts better survival. After adjusting by other covariates, age is not independently associated with survival.