Surgical resection versus watchful waiting in low-grade gliomas.
Surgical resection versus watchful waiting in low-grade gliomas.
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DOI：
10.1093/annonc/mdx230
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发表时间：
2017-08-01
期刊：
影响因子：
--
通讯作者：
Solheim O
中科院分区：
文献类型：
--
作者：
Jakola AS;Skjulsvik AJ;Myrmel KS;Sjåvik K;Unsgård G;Torp SH;Aaberg K;Berg T;Dai HY;Johnsen K;Kloster R;Solheim O
浸润性低级别胶质瘤（LGG; WHO 2级）通常在年轻人中出现癫痫发作。LGG持续生长，通常转化为更高级别的恶性肿瘤，最终导致进行性残疾和过早死亡。前期手术的效果一直存在争议，分子生物学对手术效果的影响尚不清楚。我们现在根据最近建立的分子标记物，将预先手术切除与观察等待的长期结果进行比较。以人口为基础的平行队列，从挪威的两所大学医院不同的手术治疗策略和定义的地理集水区。A区以观察等待为主，B区以早期切除为主。因此，个别患者的治疗策略取决于其居住地址。入选标准为1998年至2009年18岁或以上患者幕上LGG的组织病理学诊断。随访结束于2016年1月1日。进行区域比较，主要终点是总生存期。共纳入153例患者（66例来自A区，87例来自B区）。A区19例（29%）患者进行了早期切除，B区75例（86%）患者进行了早期切除。A区总生存期为5.8年（95% CI 4.5-7.2），而B区为14.4年（95% CI 10.4-18.5）（P < 0.01）。调整分子标记物后，手术策略的效果仍然存在（P = 0.001）。在平行的基于人群的LGG队列中，早期手术切除可获得临床相关的生存获益。对生存率的影响在调整分子标记后仍然存在。
Infiltrating low-grade gliomas (LGG; WHO grade 2) typically present with seizures in young adults. LGGs grow continuously and usually transform to higher grade of malignancy, eventually causing progressive disability and premature death. The effect of up-front surgery has been controversial and the impact of molecular biology on the effect of surgery is unknown. We now present long-term results of upfront surgical resection compared with watchful waiting in light of recently established molecular markers. Population-based parallel cohorts were followed from two Norwegian university hospitals with different surgical treatment strategies and defined geographical catchment regions. In region A watchful waiting was favored while early resection was favored in region B. Thus, the treatment strategy in individual patients depended on their residential address. The inclusion criteria were histopathological diagnosis of supratentorial LGG from 1998 through 2009 in patients 18 years or older. Follow-up ended 1 January 2016. Making regional comparisons, the primary end-point was overall survival. A total of 153 patients (66 from region A, 87 from region B) were included. Early resection was carried out in 19 (29%) patients in region A compared with 75 (86%) patients in region B. Overall survival was 5.8 years (95% CI 4.5–7.2) in region A compared with 14.4 years (95% CI 10.4–18.5) in region B (P < 0.01). The effect of surgical strategy remained after adjustment for molecular markers (P = 0.001). In parallel population-based cohorts of LGGs, early surgical resection resulted in a clinical relevant survival benefit. The effect on survival persisted after adjustment for molecular markers.
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DOI：
10.1056/nejmoa1407279
发表时间：
2015-06-25
期刊：
The New England journal of medicine
影响因子：
--
作者：
Eckel-Passow JE;Lachance DH;Molinaro AM;Walsh KM;Decker PA;Sicotte H;Pekmezci M;Rice T;Kosel ML;Smirnov IV;Sarkar G;Caron AA;Kollmeyer TM;Praska CE;Chada AR;Halder C;Hansen HM;McCoy LS;Bracci PM;Marshall R;Zheng S;Reis GF;Pico AR;O'Neill BP;Buckner JC;Giannini C;Huse JT;Perry A;Tihan T;Berger MS;Chang SM;Prados MD;Wiemels J;Wiencke JK;Wrensch MR;Jenkins RB
通讯作者：
Jenkins RB
影响因子：
6.2
作者：
Claus, EB;Horlacher, A;Black, PM
通讯作者：
Black, PM
影响因子：
120.7
作者：
Jakola, Asgeir S.;Myrmel, Kristin S.;Solheim, Ole
通讯作者：
Solheim, Ole
影响因子：
8.4
作者：
Johannesen, TB;Langmark, F;Lote, K
通讯作者：
Lote, K
影响因子：
3.9
作者：
Cordier, Dominik;Goze, Catherine;Duffau, Hugues
通讯作者：
Duffau, Hugues