Prognostic factors for survival in adult patients with recurrent glioma enrolled onto the new approaches to brain tumor therapy CNS consortium phase I and II clinical trials
Prognostic factors for survival in adult patients with recurrent glioma enrolled onto the new approaches to brain tumor therapy CNS consortium phase I and II clinical trials
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DOI：
10.1200/jco.2006.08.1661
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发表时间：
2007-06-20
影响因子：
45.3
通讯作者：
Shaw, Edward G.
中科院分区：
文献类型：
--
作者：
Carson, Kathryn A.;Grossman, Stuart A.;Shaw, Edward G.
目的：预后因素分析已被证明对预测新诊断恶性胶质瘤患者的预后是有用的。复发性胶质瘤患者的类似分析可能会影响临床试验的设计和进行substantial.Patients和MethodsBetween 1995年和2002年，333例复发性胶质瘤的成人入组到10个I期或II期试验的系统或局部治疗。这些研究具有相似的入选标准，并在脑肿瘤治疗新方法CNS联盟内进行。百分之九十三的病人已经死亡。考克斯比例风险（PH）回归和递归分区分析（RPA）进行，以确定预后factors.ResultsFactors相关的死亡风险增加的年龄，较低的Karnofsky性能评分（KPS），初始和研究组织学的多形性胶质母细胞瘤（GBM），皮质类固醇的使用，从最初的诊断到复发的时间较短，和肿瘤外额叶。最终的PH模型包括GBM的初始组织学（相对风险[RR] = 2.01），年龄增加10岁（RR = 1.23），KPS小于80（RR = 1.54）和皮质类固醇使用（RR = 1.49）。RPA导致了七个班级。KPS小于80的非GBM患者或年龄>= 50岁、使用皮质类固醇的GBM患者的中位生存时间最短（4.4个月; 95%CI，3.6 - 5.4个月）; KPS >= 80且肿瘤局限于额叶的初始组织学类型（而非GBM）患者的中位生存期最佳（25.7个月; 95%CI，18.7至52.5），为7.0个月（95%CI，6.2至8.0个月）为所有patients.ConclusionInitial组织学，年龄，KPS，和皮质类固醇的使用复发性胶质瘤患者的生存预后。为了允许在II期试验之间进行比较，可能需要限制入组标准。
PurposePrognostic factor analyses have proven useful in predicting outcome in patients with newly diagnosed malignant glioma. Similar analyses in patients with recurrent glioma could affect the design and conduct of clinical trials substantially.Patients and MethodsBetween 1995 and 2002, 333 adults with recurrent gliomas were enrolled onto 10 phase I or II trials of systemic or local therapy. The studies had similar inclusion criteria and were conducted within the New Approaches to Brain Tumor Therapy CNS Consortium. Ninety-three percent of the patients have died. Cox proportional hazards (PH) regression and recursive partitioning analysis (RPA) were performed to identify prognostic factors.ResultsFactors associated with an increased risk of death were increased age, lower Karnofsky performance score (KPS), initial and on-study histologies of glioblastoma multiforme (GBM), corticosteroid use, shorter time from original diagnosis to recurrence, and tumor outside frontal lobe. The final PH model included initial histology of GBM (relative risk [RR] = 2.01), 10-year increase in age (RR = 1.23), KPS less than 80 (RR = 1.54), and corticosteroid use (RR = 1.49). RPA resulted in seven classes. Median survival time was poorest in non-GBM patients with KPS less than 80 or GBM patients, age >= 50 years, corticosteroid use (4.4 months; 95% CI, 3.6 to 5.4 months); median survival was best in patients with initial histology other than GBM with KPS >= 80 and tumor confined to the frontal lobe (25.7 months; 95% CI, 18.7 to 52.5), and was 7.0 months (95% CI, 6.2 to 8.0 months) for all patients.ConclusionInitial histology, age, KPS, and corticosteroid use are prognostic for survival in recurrent glioma patients. To allow comparisons across phase II trials, enrollment criteria may need to be restricted.