Prognostic Value of Residual Fluorescent Tissue in Glioblastoma Patients After Gross Total Resection in 5-Aminolevulinic Acid-Guided Surgery
Prognostic Value of Residual Fluorescent Tissue in Glioblastoma Patients After Gross Total Resection in 5-Aminolevulinic Acid-Guided Surgery
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DOI：
10.1227/neu.0b013e31828c3974
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发表时间：
2013-06-01
期刊：
影响因子：
4.8
通讯作者：
Diez-Valle, Ricardo
中科院分区：
文献类型：
--
作者：
Aldave, Guillermo;Tejada, Sonia;Diez-Valle, Ricardo
背景技术背景：文献中有证据支持荧光引导手术中的荧光组织信号比T1序列磁共振成像（MRI）中的钆突出的组织延伸得更远，这是量化切除范围的标准。目的：研究胶质母细胞瘤（GBM）手术后残留荧光组织的存在是否对MRI证实的完全切除的GBM病例的预后有不同影响。我们中心的一项回顾性研究发现，118例连续的高级别胶质瘤患者使用5-氨基乙酰丙酸进行荧光引导手术。在该系列中，选择了52例在早期MRI中新诊断为GBM并完全切除增强肿瘤（CRET）的患者进行分析。我们研究了术野残留荧光对总生存率和神经系统并发症发生率的影响。多因素分析包括潜在的相关因素：年龄、Karnofsky行为量表、O-6-甲基鸟嘌呤甲基转移酶甲基化启动子状态、肿瘤功能区位置、术前肿瘤体积和辅助治疗。中位总生存期为27.0个月（置信区间= 22.4-31.6），无残留荧光的患者（n = 25）和17.5个月（置信区间= 12.5-22.5）（P = 0.015）。残留荧光的影响在所有协变量的多变量分析中得到维持，风险比= 2.5（P = 0.041）。神经系统并发症的发生率为18.5%的患者无残留荧光和8%的组残留荧光（P = 0.267）。结论：GBM患者与CRET在早期MRI和无荧光残留组织有较长的总生存期比CRET和残留荧光组织的患者。
BACKGROUND: There is evidence in the literature supporting that fluorescent tissue signal in fluorescence-guided surgery extends farther than tissue highlighted in gadolinium in T1 sequence magnetic resonance imaging (MRI), which is the standard to quantify the extent of resection.OBJECTIVE: To study whether the presence of residual fluorescent tissue after surgery carries a different prognosis for glioblastoma (GBM) cases with complete resection confirmed by MRI.METHODS: A retrospective review in our center found 118 consecutive patients with high-grade gliomas operated on with the use of fluorescence-guided surgery with 5-aminolevulinic acid. Within that series, the 52 patients with newly diagnosed GBM and complete resection of enhancing tumor (CRET) in early MRI were selected for analysis. We studied the influence of residual fluorescence in the surgical field on overall survival and neurological complication rate. Multivariate analysis included potential relevant factors: age, Karnofsky Performance Scale, O-6-methylguanine methyltransferase methylation promoter status, tumor eloquent location, preoperative tumor volume, and adjuvant therapy.RESULTS: The median overall survival was 27.0 months (confidence interval = 22.4-31.6) in patients with nonresidual fluorescence (n = 25) and 17.5 months (confidence interval = 12.5-22.5) for the group with residual fluorescence (n = 27) (P = .015). The influence of residual fluorescence was maintained in the multivariate analysis with all covariables, hazard ratio = 2.5 (P = .041). The neurological complication rate was 18.5% in patients with nonresidual fluorescence and 8% for the group with residual fluorescence (P = .267).CONCLUSION: GBM patients with CRET in early MRI and no fluorescent residual tissue had longer overall survival than patients with CRET and residual fluorescent tissue.