The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?
The butterfly effect on glioblastoma: is volumetric extent of resection more effective than biopsy for these tumors?
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DOI：
10.1007/s11060-014-1597-9
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发表时间：
2014-12
影响因子：
3.9
通讯作者：
Quinones-Hinojosa, Alfredo
中科院分区：
文献类型：
--
作者：
Chaichana, Kaisorn L.;Jusue-Torres, Ignacio;Lemos, Ana Maria;Gokaslan, Aaron;Cabrera-Aldana, Eibar Ernesto;Ashary, Ahmed;Olivi, Alessandro;Quinones-Hinojosa, Alfredo
胶质母细胞瘤（GBM）患者的一个子集具有蝶形GBM（bGBM），其通过穿过胼胝体累及两个大脑半球。由于研究很少且有限，这些疾病以及手术和辅助治疗的有效性尚不清楚。本研究的目的是：（1）确定bGBM的结局是否比非bGBM患者更差，（2）确定手术是否比活检更有效，（3）确定与这些患者结局改善独立相关的因素。回顾性分析了2007年至2012年期间在学术三级保健机构接受新诊断的原发性GBM手术的成人患者，并对肿瘤进行了体积测量。在336例接受手术的新诊断GBM患者中，48例（14%）患有bGBM，其中29例（60%）和19例（40%）分别接受了手术切除和活检。在多变量分析中，bGBM与较差的生存期独立相关[HR（95%CI）1.848（1.250-2.685），p < 0.003]。在配对分析中，接受手术切除的患者比活检患者的中位生存期延长（7.0 vs. 3.5个月，p = 0.03）。在多变量分析中，增加切除率[HR（95% CI）0. 987（0. 977 - 0. 997），p = 0. 01]、放疗[HR（95% CI）0. 431（0. 225 - 0. 812），p = 0. 009]和替莫唑胺[HR（95% CI）0. 413（0. 212 -0. 784），p = 0.007]均与bGBM患者的生存期延长独立相关。本研究表明，虽然与非bGBM相比，bGBM患者的预后较差，但这些患者也可以从积极的治疗中获益，包括减瘤手术，最大安全手术切除，替莫唑胺化疗和放射治疗。
A subset of patients with glioblastoma (GBM) have butterfly GBM (bGBM) that involve both cerebral hemispheres by crossing the corpus callosum. The prognoses, as well as the effectiveness of surgery and adjuvant therapy, are unclear because studies are few and limited. The goals of this study were to: (1) determine if bGBM have worse outcomes than patients with non-bGBM, (2) determine if surgery is more effective than biopsy, and (3) identify factors independently associated with improved outcomes for these patients. Adult patients who underwent surgery for a newly diagnosed primary GBM at an academic tertiary-care institution between 2007 and 2012 were retrospectively reviewed and tumors were volumetrically measured. Of the 336 patients with newly diagnosed GBM who were operated on, 48 (14 %) presented with bGBM, where 29 (60 %) and 19 (40 %) underwent surgical resection and biopsy, respectively. In multivariate analysis, a bGBM was independently associated with poorer survival [HR (95 % CI) 1.848 (1.250–2.685), p < 0.003]. In matched- pair analysis, patients who underwent surgical resection had improved median survival than biopsy patients (7.0 vs. 3.5 months, p = 0.03). In multivariate analysis, increasing percent resection [HR (95 % CI) 0.987 (0.977–0.997), p = 0.01], radiation [HR (95 % CI) 0.431 (0.225–0.812), p = 0.009], and temozolomide [HR (95 % CI) 0.413 (0.212–0. 784), p = 0.007] were each independently associated with prolonged survival among patients with bGBM. This present study shows that while patients with bGBM have poorer prognoses compared to non-bGBM, these patients can also benefit from aggressive treatments including debulking surgery, maximal safe surgical resection, temozolomide chemotherapy, and radiation therapy.
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影响因子：
3.9
作者：
Kallenberg, K.;Goldmann, T.;Menke, J.;Strik, H.;Bock, H. C.;Stockhammer, F.;Buhk, J. H.;Frahm, J.;Dechent, P.;Knauth, M.
通讯作者：
Knauth, M.
影响因子：
4.1
作者：
Chaichana KL;Zadnik P;Weingart JD;Olivi A;Gallia GL;Blakeley J;Lim M;Brem H;Quiñones-Hinojosa A
通讯作者：
Quiñones-Hinojosa A
影响因子：
4.1
作者：
Chang, SM;Parney, IF;Berger, M
通讯作者：
Berger, M
影响因子：
4.1
作者：
Chaichana, Kaisorn L.;Parker, Scott L.;Quinones-Hinojosa, Alfredo
通讯作者：
Quinones-Hinojosa, Alfredo
影响因子：
4.1
作者：
DEVAUX, BC;OFALLON, JR;KELLY, PJ
通讯作者：
KELLY, PJ