Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival Clinical article
Extent of resection in patients with glioblastoma: limiting factors, perception of resectability, and effect on survival Clinical article
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DOI：
10.3171/2012.8.jns12234
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发表时间：
2012-11-01
影响因子：
4.1
通讯作者：
Sagher, Oren
中科院分区：
文献类型：
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作者：
Orringer, Daniel;Lau, Darryl;Sagher, Oren
对象。切除程度（EOR）是已知的胶质母细胞瘤患者预后因素。然而，总切除（GTR）并不总是能够实现。了解预防GTR的因素有助于手术计划和患者咨询。本研究的目的是确定影响EOR的人口统计学因素、肿瘤相关因素和技术因素，并确定外科医生对EOR的印象与x线片确定的EOR之间的关系。作者对电子医疗记录进行了回顾性回顾，以确定2006年至2009年期间接受了胶质母细胞瘤切除术的所有患者，并进行了术前和术后MRI检查。46名患者被确定并纳入研究。采用图像分析软件（FIJI），根据术前和术后MRI对肿瘤大小和EOR进行体积分析。通过多变量分析，作者评估了与提高采收率和残余肿瘤体积相关的因素。可切除性的感知用双变量统计来描述，生存率用log-rank检验和Kaplan-Meier曲线来描述。肿瘤位于雄辩区（p = 0.014）和接触脑室（p = 0.031）的EOR较低。左侧顶骨肿瘤的残留体积明显大于左侧顶骨肿瘤（p = 0.042）。在该系列中，平均EOR为91.0%。69.6%（23例中的16例）的mri可证实残留肿瘤，其中GTR被外科医生发现。专家审稿人一致认为，该系列中37.0%的患者（46例中的17例）可以安全实现GTR。在可安全切除肿瘤的患者中，23.5%的患者（17例中的4例）实现了放射学完全切除。EOR大于90%的患者1年生存率（76.5%）明显高于EOR小于90%的患者（p = 0.005）。作者的研究结果证实肿瘤位置影响EOR，并提示EOR也可能受到外科医生在手术中判断残余肿瘤存在的能力的影响。外科医生在手术中判断切除是否完整的能力通常是不准确的。作者的研究证实了EOR对1年生存率的影响。(http://thejns.org/doi/abs/10.3171/2012.8.JNS12234)
Object. The extent of resection (EOR) is a known prognostic factor in patients with glioblastoma. However, gross-total resection (GTR) is not always achieved. Understanding the factors that prevent GTR is helpful in surgical planning and when counseling patients. The goal of this study was to identify demographic, tumor-related, and technical factors that influence EOR and to define the relationship between the surgeon's impression of EOR and radiographically determined EOR.Methods. The authors performed a retrospective review of the electronic medical records to identify all patients who underwent craniotomy for glioblastoma resection between 2006 and 2009 and who had both preoperative and postoperative MRI studies. Forty-six patients were identified and were included in the study. Image analysis software (FIJI) was used to perform volumetric analysis of tumor size and EOR based on preoperative and postoperative MRI. Using multivariate analysis, the authors assessed factors associated with EOR and residual tumor volume. Perception of resectability was described using bivariate statistics, and survival was described using the log-rank test and Kaplan-Meier curves.Results. The EOR was less for tumors in eloquent areas (p = 0.014) and those touching ventricles (p = 0.031). Left parietal tumors had significantly greater residual volume (p = 0.042). The average EOR was 91.0% in this series. There was MRI-demonstrable residual tumor in 69.6% of cases (16 of 23) in which GTR was perceived by the surgeon. Expert reviewers agreed that GTR could be safely achieved in 37.0% of patients (17 of 46) in this series. Among patients with safely resectable tumors, radiographically complete resection was achieved in 23.5% of patients (4 of 17). An EOR greater than 90% was associated with a significantly greater 1-year survival (76.5%) than an EOR less than 90% (p = 0.005).Conclusions. The authors' findings confirm that tumor location affects EOR and suggest that EOR may also be influenced by the surgeon's ability to judge the presence of residual tumor during surgery. The surgeon's ability to judge completeness of resection during surgery is commonly inaccurate. The authors' study confirms the impact of EOR on 1-year survival. (http://thejns.org/doi/abs/10.3171/2012.8.JNS12234)