The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma.
The Survival Benefits of Surgical Resection and Adjuvant Therapy for Patients With Brainstem Glioma.
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手术切除和辅助治疗对脑干胶质瘤患者的生存益处
DOI：
10.3389/fonc.2021.566972
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发表时间：
2021
影响因子：
4.7
通讯作者：
Cheng Q
中科院分区：
文献类型：
--
作者：
Liu Z;Feng S;Li J;Cao H;Huang J;Fan F;Cheng L;Liu Z;Cheng Q
手术切除在脑干胶质瘤(BSG)治疗中的作用还知之甚少。对于儿童低级别(LGBSG)组，几项单中心小规模回顾研究报告了相互矛盾的结论。目前还没有针对成人或儿童高度恶性(HG)患者组的手术切除的临床研究。本研究旨在阐明手术切除和辅助治疗是否能为组织学证实的BSG患者提供生存益处。这项回顾性队列研究包括2006年至2015年期间在监测流行病学和最终结果(SEER)数据库中经组织学证实的529名BSG患者。根据年龄和世界卫生组织(WHO)分级将患者分为四组。绘制不同治疗方案下CS的Kaplan-Meier曲线，比较生存概率。然后进行单变量和多变量分析，以确定手术切除和辅助治疗对肿瘤特异性生存(CS)的预后影响。所有的分析分别在四个不同的组中进行。最终样本包括529名患者。将研究人群分为儿童LG(n=236，44.6%)、儿童HG(n=37，7.0%)、成人LG(n=204，38.6%)和成人HG(n=52，9.8%)。52.7%(n=144)的儿童患者为毛细胞性星形细胞瘤，45.3%(n=116)的成人患者为室管膜瘤。儿童LGBSG组的肿瘤大部切除率(61.4%)和5年切除率(88.6%)最高。卡普兰-迈耶曲线显示，接受胃肠外营养支持组患者的生存概率明显高于对照组(P=0.033)。多变量分析显示，在儿科LGBSG组中，牙周膜返流是延长CS的独立显著预测因素(HR0.29，95%CI0.11~0.78，P=0.015)；在其他患者组中，手术切除与CS无关。成人HGBSG组Kaplan-Meier曲线显示，同时接受放疗和CT治疗的患者生存概率最高(P=0.02)。多因素分析显示，放疗(RT)和化疗(CT)的联合应用与成人HGBSG组的临床症状改善无明显相关性(HR0.35，95%CI0.11~1.09，P=0.070)。在其他患者组中，辅助治疗与较好的CS无关。儿童LGBSG组GTR率最高，临床转归最好。GTR可为儿童LGBSG组提供显著的生存益处。
The role of surgical resection in the treatment of brainstem glioma (BSG) is poorly understood. For pediatric low-grade (LGBSG) group, several monocentric small-scale retrospective studies reported contradictory conclusions. And there was no clinical study focused on surgical resection for adult or pediatric high-grade (HG) patient groups. This study aims to illustrate whether surgical resection and adjuvant therapy provide survival benefits for patients with histologically confirmed BSG. This retrospective cohort study included 529 patients with histologically confirmed BSG in Surveillance Epidemiology and End Results (SEER) database from 2006-2015. Patients were divided into four groups by age and World Health Organization (WHO) grade. Kaplan-Meier curves of CSS were plotted by different treatment options to compare the survival probability. Univariate and multivariable analyses were then conducted to determine the prognosis effects of surgical resection and adjuvant therapy on cancer specific survival (CSS). All analyses were done in four different groups separately. The final sample included 529 patients. The entire study population was divided into groups of pediatric LG (n=236, 44.6%), pediatric HG (n=37, 7.0%), adult LG (n=204, 38.6%) and adult HG (n=52, 9.8%). 52.7% (n=144) of pediatric patients had pilocytic astrocytoma and 45.3% (n=116) of adult patients had ependymoma. Pediatric LGBSG group had the highest gross total resection (GTR) rate (61.4%) and 5-year CSS rate (88.6%). Kaplan-Meier curves of pediatric LGBSG group revealed that patients treated with GTR had significantly better survival probability (P=0.033). Multivariable analysis identified GTR as independently significant predictor for prolonged CSS in pediatric LGBSG group (HR0.29, 95%CI 0.11-0.78, P=0.015); Surgical resection showed no relation to CSS in other patient groups. Kaplan-Meier curves of adult HGBSG group showed that patients treated with both RT and CT in adult HGBSG group had the best survival probability (P=0.02). However, multivariable analysis showed the combination of radiotherapy (RT) and chemotherapy (CT) was not significantly related to better CSS in adult HGBSG group (HR0.35, 95%CI 0.11-1.09, P=0.070). Adjuvant therapy didn’t associate with better CSS in other patient groups. Pediatric LGBSG group had the highest GTR rate and the most favorable clinical outcome. GTR can provide significant survival benefits for pediatric LGBSG group.
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影响因子：
3.9
作者：
Kesari, Santosh;Kim, Ryung S.;Pruitt, Amy A.
通讯作者：
Pruitt, Amy A.
影响因子：
2.8
作者：
Kim, Yi-Jun;Lee, David J.;Kim, In Ah
通讯作者：
Kim, In Ah
DOI：
10.4103/ajns.ajns_101_19
发表时间：
2019-10-01
期刊：
Asian journal of neurosurgery
影响因子：
--
作者：
Laghari, Altaf Ali;Baig, Mirza Zain;Khan, Daniyal Aziz
通讯作者：
Khan, Daniyal Aziz
影响因子：
3.9
作者：
Negretti, Laura;Bouchireb, Karim;Dufour, Christelle
通讯作者：
Dufour, Christelle
影响因子：
1.1
作者：
Sinha, Sumit;Kale, Shashank Sharad;Sharma, Bhawani S.
通讯作者：
Sharma, Bhawani S.