Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance
Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance
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DOI：
10.1002/cncr.20867
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发表时间：
2005-03-15
期刊：
影响因子：
6.2
通讯作者：
Black, PM
中科院分区：
文献类型：
--
作者：
Claus, EB;Horlacher, A;Black, PM
背景资料。对于使用术中磁共振成像(MRI)指导进行低级别胶质瘤切除的神经外科患者，目前还没有年龄调整或组织学调整的评估来评估切除范围与复发或死亡风险之间的关系。方法：研究方法。目前的数据包括在1997年1月1日至2003年1月31日期间，在布里格姆妇女医院的MRI套件中接受手术切除单灶性幕上低级别胶质瘤的156名患者。使用Kaplan-Meier方法计算无病生存概率和总体生存概率。切除范围和这些概率之间的关联通过COX比例风险模型来衡量。使用从监测、流行病学和最终结果登记处获得的特定年龄和特定组织学存活率，将观察死亡率与预期死亡率进行比较。结果。与大部切除的患者相比，接受大部切除的患者疾病复发风险(95%可信区间[95%CI]，0.7-3.1)和死亡风险(95%CI，0.61-40.0)分别是1.4倍和4.9倍。在术中MRI引导下接受手术切除的患者的1、2和5年年龄调整和组织学调整的死亡率分别为1.9%(95%CI，0.3-4.2%)、3.6%(95%CI，0.4-6.7%)和17.6%(95%CI，5.9-29.3%)：显著低于国家数据库报道的死亡率。结论。目前研究的数据表明，在术中MRI指导下接受低级别胶质瘤手术的神经外科患者，手术切除与生存之间可能存在关联。需要在一个大型的、预期的、以人口为基础的项目范围内进行进一步的研究，以证实这些发现。癌症2005；103：1227-33。(C)2005年美国癌症协会。
BACKGROUND. No age-adjusted or histologic-adjusted assessments of the association between extent of resection and risk of either recurrence or death exist for neurosurgical patients who undergo resection of low-grade glioma using intraoperative magnetic resonance image (MRI) guidance. METHODS. The current data included 156 patients who underwent surgical resection of a unifocal, supratentorial, low-grade glioma in the MRI suite at Brigham and Women's Hospital between January 1, 1997, and January 31, 2003. Estimates of disease-free and overall survival probabilities were calculated using Kaplan-Meier methodology. The association between extent of resection and these probabilities was measured using a Cox proportional hazards model. Observed death rates were compared with the expected death rate using age-specific and histologic- specific survival rates obtained from the Surveillance, Epidemiology, and End Results Registry. RESULTS. Patients who underwent subtotal resection were at 1.4 times the risk of disease recurrence (95% confidence interval [95% Cl], 0.7-3.1) and at 4.9 times the risk of death (95% Cl, 0.61-40.0) relative to patients who underwent gross total resection. The 1-year, 2-year, and 5-year age-adjusted and histologic- adjusted death rates for patients who underwent surgical resection using intraoperative MRI guidance were 1.9% (95% Cl, 0.3-4.2%), 3.6% (95% Cl, 0.4-6.7%), and 17.6% (95% Cl, 5.9-29.3%), respectively: significantly lower than the rates reported using national data bases. CONCLUSIONS. The data from the current study suggested a possible association between surgical resection and survival for neurosurgical patients who underwent surgery for low-grade glioma under intraoperative MRI guidance. Further study within the context of a large, prospective, population-based project will be needed to confirm these findings. Cancer 2005;103:1227-33. (C) 2005 American Cancer Society.