Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable.
Pre-Radiotherapy Progression after Surgery of Newly Diagnosed Glioblastoma: Corroboration of New Prognostic Variable.
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DOI：
10.3390/diagnostics10090676
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发表时间：
2020-09-05
期刊：
影响因子：
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通讯作者：
Slaby O
中科院分区：
文献类型：
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作者：
Lakomy R;Kazda T;Selingerova I;Poprach A;Pospisil P;Belanova R;Fadrus P;Smrcka M;Vybihal V;Jancalek R;Kiss I;Muckova K;Hendrych M;Knight A;Sana J;Slampa P;Slaby O
背景资料：这项回顾性研究的目的是评估新诊断的胶质母细胞瘤患者在开始放疗前快速早期进展（REP）的发生率、定位和潜在预测因素，并比较有或无REP的队列中与治疗相关的生存结局。方法：我们评估了2014年1月至2017年12月期间155例经组织学证实的放射性胶质母细胞瘤患者的连续队列。共分析了90例患者的术前、术后和计划MRI。结果：中位年龄59岁，59%为男性，39例患者（43%）接受了肿瘤全切除术。Stupp方案适用于64例患者（71%）; 26例患者（29%）仅接受放疗。46例（51%）患者在放疗前不久进行的计划MRI上发现REP，最常见于手术腔壁内，REP的主要预测因素是非根治性手术（p < 0.001）。REP的存在被证实是一个强有力的负面预后因素; REP患者的中位总生存期（OS）为10.7 vs. 18.7个月，2年生存率为15.6% vs. 37.7%（无REP患者的风险比HR 0.53; p = 0.007）。有趣的是，REP发生对生存结局的影响在年轻患者（≤ 50岁）和老年患者（> 50岁）中的OS（p = 0.047）和PFS（p = 0.341）方面存在显著差异。在年轻患者中，REP是一个更强的负性预后因素，可能是由于更具侵略性的行为。与单独放疗相比，适用Stupp方案的REP患者的OS更长（中位OS 16.0 vs 7.5; HR = 0.5，p = 0.022; 2年生存率22.3% vs 5.6%）。手术和放疗的开始之间的时间间隔，无论是在整个队列或在REP患者的预后。结论：特别是在亚组的患者没有根治性切除术，可以建议尽早开始放疗。REP现象应被视为分层因素的一个组成部分，在未来的前瞻性临床试验中招募患者开始放疗前。
Background: The aim of this retrospective study is to assess the incidence, localization, and potential predictors of rapid early progression (REP) prior to initiation of radiotherapy in newly diagnosed glioblastoma patients and to compare survival outcomes in cohorts with or without REP in relation to the treatment. Methods: We assessed a consecutive cohort of 155 patients with histologically confirmed irradiated glioblastoma from 1/2014 to 12/2017. A total of 90 patients with preoperative, postoperative, and planning MRI were analyzed. Results: Median age 59 years, 59% men, and 39 patients (43%) underwent gross total tumor resection. The Stupp regimen was indicated to 64 patients (71%); 26 patients (29%) underwent radiotherapy alone. REP on planning MRI performed shortly prior to radiotherapy was found in 46 (51%) patients, most often within the surgical cavity wall, and the main predictor for REP was non-radical surgery (p < 0.001). The presence of REP was confirmed as a strong negative prognostic factor; median overall survival (OS) in patients with REP was 10.7 vs. 18.7 months and 2-year survival was 15.6% vs. 37.7% (hazard ratio HR 0.53 for those without REP; p = 0.007). Interestingly, the REP occurrence effect on survival outcome was significantly different in younger patients (≤ 50 years) and older patients (> 50 years) for OS (p = 0.047) and non-significantly for PFS (p = 0.341). In younger patients, REP was a stronger negative prognostic factor, probably due to more aggressive behavior. Patients with REP who were indicated for the Stupp regimen had longer OS compared to radiotherapy alone (median OS 16.0 vs 7.5; HR = 0.5, p = 0.022; 2-year survival 22.3% vs. 5.6%). The interval between surgery and the initiation of radiotherapy were not prognostic in either the entire cohort or in patients with REP. Conclusion: Especially in the subgroup of patients without radical resection, one may recommend as early initiation of radiotherapy as possible. The phenomenon of REP should be recognized as an integral part of stratification factors in future prospective clinical trials enrolling patients before initiation of radiotherapy.
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