Patient-specific metrics of invasiveness reveal significant prognostic benefit of resection in a predictable subset of gliomas.
Patient-specific metrics of invasiveness reveal significant prognostic benefit of resection in a predictable subset of gliomas.
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DOI：
10.1371/journal.pone.0099057
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Swanson KR
中科院分区：
文献类型：
--
作者：
Baldock AL;Ahn S;Rockne R;Johnston S;Neal M;Corwin D;Clark-Swanson K;Sterin G;Trister AD;Malone H;Ebiana V;Sonabend AM;Mrugala M;Rockhill JK;Silbergeld DL;Lai A;Cloughesy T;McKhann GM 2nd;Bruce JN;Rostomily RC;Canoll P;Swanson KR
恶性胶质瘤是无法治愈的原发性脑肿瘤，因其可能广泛侵入脑实质而闻名。目前的临床影像方法无法阐明脑部侵犯的全部范围，因此很难预测哪些患者（如果有的话）可能从大体全切除中受益。我们的目标是应用数学模型方法来估计每个患者的整体肿瘤侵袭性，并确定总体切除是否会提高侵袭性相对较小的胶质瘤患者的生存率。在 243 名患有对比增强神经胶质瘤的患者中，通过将患者特异性数学模型应用于常规预处理 MR 成像，得出了每位患者肿瘤相对侵袭性的估计值，即神经胶质瘤细胞的净增殖率与其净扩散率的比率。对按肿瘤侵袭性分组的患者队列评估了不同程度的切除范围对总体生存率的影响。我们证明，与次全切除/活检相比，具有更弥漫性肿瘤的患者在大体全切除中没有表现出生存获益（P = 0.532），而那些结节性（不太弥漫性）肿瘤的患者则表现出显着的获益（P = 0.00142），与同一队列中的次全切除肿瘤相比，中位生存获益显着超过8个月（仅针对结节性肿瘤，GTR的生存时间提高了80%）肿瘤）。这些结果表明，我们针对特定患者、基于模型的肿瘤侵袭性估计在手术决策中具有临床实用性。根据常规获得的术前影像评估相对侵袭性的量化提供了总切除获益的实用预测指标。
Malignant gliomas are incurable, primary brain neoplasms noted for their potential to extensively invade brain parenchyma. Current methods of clinical imaging do not elucidate the full extent of brain invasion, making it difficult to predict which, if any, patients are likely to benefit from gross total resection. Our goal was to apply a mathematical modeling approach to estimate the overall tumor invasiveness on a patient-by-patient basis and determine whether gross total resection would improve survival in patients with relatively less invasive gliomas. In 243 patients presenting with contrast-enhancing gliomas, estimates of the relative invasiveness of each patient's tumor, in terms of the ratio of net proliferation rate of the glioma cells to their net dispersal rate, were derived by applying a patient-specific mathematical model to routine pretreatment MR imaging. The effect of varying degrees of extent of resection on overall survival was assessed for cohorts of patients grouped by tumor invasiveness. We demonstrate that patients with more diffuse tumors showed no survival benefit (P = 0.532) from gross total resection over subtotal/biopsy, while those with nodular (less diffuse) tumors showed a significant benefit (P = 0.00142) with a striking median survival benefit of over eight months compared to sub-totally resected tumors in the same cohort (an 80% improvement in survival time for GTR only seen for nodular tumors). These results suggest that our patient-specific, model-based estimates of tumor invasiveness have clinical utility in surgical decision making. Quantification of relative invasiveness assessed from routinely obtained pre-operative imaging provides a practical predictor of the benefit of gross total resection.
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影响因子：
--
作者：
Swanson, Kristin R.
通讯作者：
Swanson, Kristin R.
影响因子：
8.5
作者：
Swanson, KR;Alvord, EC;Murray, JD
通讯作者：
Murray, JD
影响因子：
45.3
作者：
Park, John K.;Hodges, Tiffany;Black, Peter McL.
通讯作者：
Black, Peter McL.
影响因子：
3.5
作者：
Rockne R;Rockhill JK;Mrugala M;Spence AM;Kalet I;Hendrickson K;Lai A;Cloughesy T;Alvord EC Jr;Swanson KR
通讯作者：
Swanson KR
影响因子：
4.1
作者：
Sanai, Nader;Polley, Mei-Yin;Berger, Mitchel S.
通讯作者：
Berger, Mitchel S.