RESECTION, BIOPSY, AND SURVIVAL IN MALIGNANT GLIAL NEOPLASMS - A RETROSPECTIVE STUDY OF CLINICAL-PARAMETERS, THERAPY, AND OUTCOME
RESECTION, BIOPSY, AND SURVIVAL IN MALIGNANT GLIAL NEOPLASMS - A RETROSPECTIVE STUDY OF CLINICAL-PARAMETERS, THERAPY, AND OUTCOME
复制标题
DOI：
10.3171/jns.1993.78.5.0767
复制
发表时间：
1993-05-01
影响因子：
4.1
通讯作者：
KELLY, PJ
中科院分区：
文献类型：
--
作者：
DEVAUX, BC;OFALLON, JR;KELLY, PJ
从1984年7月至1988年10月，对263例（男163例，女100例）年龄4 ~ 83岁（平均52岁）的恶性脑胶质瘤患者进行了手术治疗，其中160例立体定向活检，103例切除。IV级星形细胞瘤170例，IV级混合性少突星形细胞瘤17例，III级星形细胞瘤44例，III级混合性少突星形细胞瘤22例，恶性少突胶质细胞瘤10例。IV级胶质瘤的总体中位生存时间为30.1周，III级胶质瘤为87.7周，恶性少突胶质细胞瘤为171.3周。对218例新诊断病例的多变量分析显示，与生存时间最密切相关的变量是：肿瘤分级、患者年龄、首发症状为癫痫发作、Karnofsky行为量表评分低于70%、肿瘤切除和放射治疗剂量大于50戈伊。在这些预后因素组中，接受肿瘤切除与活检的患者比例相似。由于22名中线和脑干肿瘤患者中的大多数仅接受活检治疗，因此将其排除在外。考虑到196名新诊断的皮质和皮质下肿瘤患者，接受对比增强肿块切除术的IV级胶质瘤患者（如计算机断层扫描和磁共振成像所示）术后外照射治疗比单纯活检和放疗的患者生存时间长（中位生存时间分别为50.6周和33.0周; Smirnov检验，p = 0.0380）。然而，切除的III级胶质瘤患者的生存率并不比活检的III级病变患者好（p = 0.746）。作者得出结论，在选定的IV级胶质瘤中，切除对比增强肿块后进行放射治疗与单纯活检后放射治疗相比，生存时间更长。
Between July, 1984, and October, 1988, 263 patients (163 male, 100 female), aged from 4 to 83 years (mean 52 years), with malignant brain gliomas underwent surgical procedures: stereotactic biopsy in 160 and resection in 103 patients. There were 170 grade IV astrocytomas, 17 grade IV mixed oligoastrocytomas, 44 grade III astrocytomas, 22 grade III mixed oligoastrocytomas, and 10 malignant oligodendrogliomas. Overall median survival time was 30.1 weeks for grade IV gliomas, 87.7 weeks for grade III gliomas, and 171.3 weeks for malignant oligodendrogliomas. Multivariate analysis in 218 newly diagnosed cases revealed that the variables most strongly correlated with survival time were: tumor grade, patient age, seizures as a first symptom, a Karnofsky Performance Scale score of less than 70%, tumor resection, and a radiation therapy dose greater than 50 Gy. The proportions of patients receiving tumor resection versus biopsy in each of these prognosis factor groups were similar. Since most of the 22 patients with midline and brain-stem tumors were treated with biopsy alone, these were excluded.Considering 196 newly diagnosed patients with cortical and subcortical tumors, grade IV glioma patients undergoing resection of the contrast-enhancing mass (as evidenced on computerized tomography and magnetic resonance imaging) and postoperative external beam radiation therapy lived longer than those undergoing biopsy only and radiation therapy (median survival time 50.6 weeks and 33.0 weeks, respectively; Smirnov test, p = 0.0380). However, survival in patients with resected grade III gliomas was no better than in those with biopsied grade III lesions (p = 0.746). The authors conclude that, in selected grade IV gliomas, resection of the contrast-enhancing mass followed by radiation therapy is associated with longer survival times than radiation therapy after biopsy alone.