Scale to Predict Survival After Surgery for Recurrent Glioblastoma Multiforme
Scale to Predict Survival After Surgery for Recurrent Glioblastoma Multiforme
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DOI：
10.1200/jco.2010.30.0582
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发表时间：
2010-08-20
影响因子：
45.3
通讯作者：
Black, Peter McL.
中科院分区：
文献类型：
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作者：
Park, John K.;Hodges, Tiffany;Black, Peter McL.
目的尽管通过手术切除、放疗和化疗进行初步治疗，但多形性胶质母细胞瘤 (GBM) 实际上总是会复发。有时建议手术治疗复发。在这项研究中，我们试图设计一个术前量表来预测复发性多形性胶质母细胞瘤术后的生存率。 患者和方法使用 Kaplan-Meier 生存分析和 Cox 比例风险回归模型对 34 名接受复发性 GBM 肿瘤再次手术的患者的术前临床和影像学数据进行分析。与术后生存率降低相关的因素 (P = 0.05) 用于设计一个预后量表，并在 109 名患者的单独队列中进行了验证。 结果 与术后生存率较差相关的因素是：肿瘤累及预先指定的功能/关键脑区 (P = 021)、卡诺夫斯基功能状态 (KPS) = 80 (P = 030) 和肿瘤体积 50 cm3 (P = 048)。由这三个变量组成的加法量表（范围，0 至 3 分）区分术后生存良好（0 分）、中等（1 至 2 分）和较差（3 分）的患者（中位生存分别为 10.8、4.5 和 1.0 个月；P=.001）。该量表还确定了验证队列中三个统计上不同的组（中位生存期分别为 9.2、6.3 和 1.9 个月；P = 001）。结论我们设计并验证了术前量表，该量表可识别复发性 GBM 肿瘤手术切除后可能具有较差、中等和良好相对结果的患者。这种简单量表的应用可能有助于为患者提供治疗选择方面的咨询和设计临床试验。
PurposeDespite initial treatment with surgical resection, radiotherapy, and chemotherapy, glioblastoma multiforme (GBM) virtually always recurs. Surgery is sometimes recommended to treat recurrence. In this study, we sought to devise a preoperative scale that predicts survival after surgery for recurrent glioblastoma multiforme.Patients and MethodsThe preoperative clinical and radiographic data of 34 patients who underwent re-operation of recurrent GBM tumors were analyzed using Kaplan-Meier survival analysis and Cox proportional hazards regression modeling. The factors associated with decreased postoperative survival (P =.05) were used to devise a prognostic scale which was validated with a separate cohort of 109 patients.ResultsThe factors associated with poor postoperative survival were: tumor involvement of prespecified eloquent/ critical brain regions (P =021), Karnofsky performance status (KPS)= 80 (P =030), and tumor volume 50 cm3 (P =048). An additive scale (range, 0 to 3 points) comprised of these three variables distinguishes patients with good (0 points), intermediate (1 to 2 points), and poor (3 points) postoperative survival (median survival, 10.8, 4.5, and 1.0 months, respectively; P=.001). The scale identified three statistically distinct groups within the validation cohort as well (median survival, 9.2, 6.3, and 1.9 months, respectively; P = 001).ConclusionWe devised and validated a preoperative scale that identifies patients likely to have poor, intermediate, and good relative outcomes after surgical resection of a recurrent GBM tumor. Application of this simple scale may be useful in counseling patients regarding their treatment options and in designing clinical trials.