Patterns of failure after multimodal treatments for high-grade glioma: effectiveness of MIB-1 labeling index.
Patterns of failure after multimodal treatments for high-grade glioma: effectiveness of MIB-1 labeling index.
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DOI：
10.1186/1748-717x-7-104
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发表时间：
2012-06-26
期刊：
影响因子：
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通讯作者：
Sasaki R
中科院分区：
文献类型：
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作者：
Uehara K;Sasayama T;Miyawaki D;Nishimura H;Yoshida K;Okamoto Y;Mukumoto N;Akasaka H;Nishihara M;Fujii O;Soejima T;Sugimura K;Kohmura E;Sasaki R
本研究的目的是分析高级别胶质瘤多模式治疗的复发模式，并评估MIB-1标记指数（LI）是否可以作为预测胶质母细胞瘤（GB）失败模式的有用标志物。我们评估了131例经组织学证实的间变性星形细胞瘤（AA）或GB患者。中位剂量为60戈伊。111例患者接受了伴随和辅助化疗。采用免疫组化法检测MIB-1 LI。根据复发区域将复发模式分类如下：中心衰竭（60戈伊的95%内复发）;射野内（50戈伊高剂量体积内复发）;边缘（高剂量体积外复发）和远处（RT野外复发）。所有患者的中位随访时间为13个月，其余存活患者为19个月。在AA患者中，2年无进展生存率和总生存率分别为23.1%和39.2%，而在GB患者中，2年无进展生存率和总生存率分别为13.3%和27.6%。中位生存期AA患者为20个月，GB患者为15个月。在AA患者中，68.7%的患者复发为中央复发，18.8%为场内复发，12.5%为远处复发，而在GB患者中，69.0%的复发为中央复发，15.5%为场内复发，12.1%为边缘复发，3.4%为远处复发。MIB-1 LI中位数在AA中为18.2%，在GB中为29.8%。有趣的是，在GB患者中，MIB-1 LI对失败模式有很强的影响（P = 0.014），而手术切除程度（P = 0.47）和化疗方案（P = 0.57）则没有影响。MIB-1 LI主要影响采用多模式方法治疗的GB患者的失败模式，并且它可能是疾病管理的有用工具。
The purpose of the present study was to analyze the recurrence pattern of high-grade glioma treated with a multimodal treatment approach and to evaluate whether the MIB-1 labeling index (LI) could be a useful marker for predicting the pattern of failure in glioblastoma (GB). We evaluated histologically confirmed 131 patients with either anaplastic astrocytoma (AA) or GB. A median dose was 60 Gy. Concomitant and adjuvant chemotherapy were administered to 111 patients. MIB-1 LI was assessed by immunohistochemistry. Recurrence patterns were categorized according to the areas of recurrence as follows: central failure (recurrence in the 95% of 60 Gy); in-field (recurrence in the high-dose volume of 50 Gy; marginal (recurrence outside the high-dose volume) and distant (recurrence outside the RT field). The median follow-up durations were 13 months for all patients and 19 months for those remaining alive. Among AA patients, the 2-year progression-free and overall survival rates were 23.1% and 39.2%, respectively, while in GB patients, the rates were 13.3% and 27.6%, respectively. The median survival time was 20 months for AA patients and 15 months for GB patients. Among AA patients, recurrences were central in 68.7% of patients; in-field, 18.8%; and distant, 12.5%, while among GB patients, 69.0% of recurrences were central, 15.5% were in-field, 12.1% were marginal, and 3.4% were distant. The MIB-1 LI medians were 18.2% in AA and 29.8% in GB. Interestingly, in patients with GB, the MIB-1 LI had a strong effect on the pattern of failure (P = 0.014), while the extent of surgical removal (P = 0.47) and regimens of chemotherapy (P = 0.57) did not. MIB-1 LI predominantly affected the pattern of failure in GB patients treated with a multimodal approach, and it might be a useful tool for the management of the disease.