Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas Clinical article
Recurrence and malignant degeneration after resection of adult hemispheric low-grade gliomas Clinical article
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DOI：
10.3171/2008.10.jns08608
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发表时间：
2010-01-01
影响因子：
4.1
通讯作者：
Quinones-Hinojosa, Alfredo
中科院分区：
文献类型：
--
作者：
Chaichana, Kaisorn L.;McGirt, Matthew J.;Quinones-Hinojosa, Alfredo
Object.与恶性胶质瘤不同，低级别胶质瘤与生存期延长有关。然而，这些肿瘤在切除后有进展的倾向，并最终发生恶性变性。与复发和恶性变相关的因素仍然相对未知。作者着手确定与接受半球低级别胶质瘤切除术的患者的复发和恶性变性独立相关的因素。回顾性分析了1996年至2006年在约翰霍普金斯医学研究所的学术三级保健机构接受开颅术和半球低级别胶质瘤（WHO 11级）切除术的成人患者。采用多因素比例风险回归分析确定肿瘤复发和恶性变性的相关性。在该系列中的191例低级别胶质瘤连续患者（89例星形细胞瘤，89例少突胶质细胞瘤和13例混合性胶质瘤）中，83例（43%）和44例（23%）在末次随访时分别发生肿瘤复发和恶性变性。5年无进展生存率为44%，无恶性肿瘤生存率为74%。复发的独立预测因素是持续时间最长的症状（相对风险[RR] 0.978，95% CI 0.954-0.996，p = 0.01），肿瘤大小（RR 1.328，95% CI 1.109-1.602，p = 0.002）和术前对比增强（RR 2.558，95% CI 1.241-5.021，p = 0.01）。与恶性变相关的独立因素是星形细胞瘤病理类型（RR 1.800，95% CI 1.008-4.928，p = 0.04），肿瘤大小（RR 1.086，95%CI 1.044-1.358，p = 0.04）和大体全切（RR 0.526，95%CI 0.221-1.007，p = 0.05）。识别和考虑与复发和恶性进展相关的因素可能有助于指导治疗策略，旨在延迟复发和预防半球低级别胶质瘤患者的恶性变性。(DOI：10.3171/2008.10.JNS08608）
Object. Unlike their malignant counterparts, low-grade gliomas are associated with prolonged survival. However, these tumors have a propensity to progress after resection and ultimately undergo malignant degeneration. The factors associated with recurrence and malignant degeneration remain relatively unknown. The authors set out to determine factors that were independently associated with recurrence and malignant degeneration in patients who underwent resection of a hemispheric low-grade glioma.Methods. Adult patients who underwent craniotomy and resection of a hemispheric low-grade glioma (WHO Grade 11) at the Johns Hopkins Medical Institution's academic tertiary-care institution between 1996 and 2006 were retrospectively reviewed. Multivariate proportional hazards regression analyses were used to identify associations with tumor recurrence and malignant degeneration.Results. Of the 191 consecutive patients with low-grade gliomas in this series (89 fibrillary astrocytomas, 89 oligodendrogliomas, and 13 mixed gliomas), 83 (43%) and 44 (23%) experienced tumor recurrence and malignant degeneration at last follow-up, respectively. The 5-year progress ion-free and malignancy-free survival rates were 44 and 74%, respectively. Independent predictors of recurrence were duration of longest lasting symptom (relative risk [RR] 0.978, 95% CI 0.954-0.996, p = 0.01), tumor size (RR 1.328, 95% CI 1.109-1.602 p = 0.002), and preoperative contrast enhancement (RR 2.558, 95% CI 1.241-5.021, p = 0.01). Independent factors associated with malignant degeneration were fibrillary astrocytoma pathology (RR 1.800, 95% Cl 1.008-4.928, p = 0.04), tumor size (RR 1.086, 95% Cl 1.044-1.358, p = 0.04), and gross-total resection (RR 0.526,95% CI 0.221-1.007, p = 0.05).Conclusions. The identification and consideration of factors associated with recurrence and malignant progression may help guide treatment strategies aimed at delaying recurrence and preventing malignant degeneration for patients with hemispheric low-grade gliomas. (DOI: 10.3171/2008.10.JNS08608)