Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping
Impact of the extent of resection on the survival of patients with grade II and III gliomas using awake brain mapping
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DOI：
10.1007/s11060-021-03776-w
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发表时间：
2021-05-19
影响因子：
3.9
通讯作者：
Saito, Ryuta
中科院分区：
文献类型：
--
作者：
Motomura, Kazuya;Chalise, Lushun;Saito, Ryuta
目的：本研究的目的是评估肿瘤切除程度（EOR）对接受清醒脑地形图检查的II级和III级胶质瘤（GII/III-胶质瘤）患者生存率的影响。方法回顾性分析2012年12月至2020年5月在同一机构接受清醒脑手术的126例优势半球和非优势半球GII/III-胶质瘤患者。结果通过5年无进展生存期（PFS）的受试者操作特征（ROC）分析确定改善无进展生存期（PFS）的EOR截止值。EOR的ROC显示临界值>= 85.3%。在EOR ≥ 100%的GII/III期胶质瘤患者组中，包括耳上切除术（n = 47;中位生存期[MS]，未达到）的中位PFS率显著高于EOR < 90%的组（n = 52; MS，43.1个月; 95%CI 37.7-48.5个月; p = 0.03）。在弥漫性星形细胞瘤和间变性星形细胞瘤患者中，EOR >= 100%（包括耳上切除术）组（n = 25; MS，未达到）的PFS率显著优于EOR < 100%组（n = 45; MS，35.8个月; 95%CI 19.9-51.6个月; p = 0.03）。在IDH突变型弥漫性星形细胞瘤和间变性星形细胞瘤中，全切除或大体全切除与更好的PFS相关（n = 19; MS，未达到vs. n = 35; MS，40.6个月; 95% CI 22.3-59.0个月; p = 0.02）。相比之下，在IDH野生型弥漫性星形细胞瘤和间变性星形细胞瘤患者中，耳上或大体全切除与PFS率延长无关。结论本研究表明，肿瘤EOR与GII/III期胶质瘤患者的生存率显著相关。5年PFS的EOR临界值为>= 85.3%。值得注意的是，在IDH突变型WHO II级和III级星形细胞肿瘤中，耳上或大体全切除术与更好的PFS显著相关。鉴于我们发现EOR与侵袭性IDH-野生型弥漫性星形细胞瘤和间变性星形细胞瘤患者的PFS无关，我们建议需要更强化的治疗来控制这些肿瘤。
Purpose The aim of this study was to assess the effect of the extent of resection (EOR) of tumors on survival in a series of patients with grade II and III gliomas (GII/III-gliomas) who underwent awake brain mapping. Methods We retrospectively analyzed 126 patients with GII/III-gliomas in the dominant and non-dominant hemisphere who underwent awake brain surgery at the same institution between December 2012 and May 2020. Results EOR cut-off values for improved progression-free survival (PFS) were determined by a receiver operator characteristic (ROC) analysis of 5-year PFS. The ROC for EOR showed a cut-off value of >= 85.3%. The median PFS rate of patients with GII/III-gliomas in the group with an EOR >= 100%, including supratotal resection (n = 47; median survival [MS], not reached), was significantly higher than that in the group with an EOR < 90% (n = 52; MS, 43.1 months; 95% CI 37.7-48.5 months; p = 0.03). In patients with diffuse astrocytomas and anaplastic astrocytomas, the group with EOR >= 100%, including supratotal resection (n = 25; MS, not reached), demonstrated a significantly better PFS rate than did the group with an EOR < 100% (n = 45; MS, 35.8 months; 95% CI 19.9-51.6 months; p = 0.03). Supratotal or gross total resection was correlated with better PFS in IDH-mutant type of diffuse astrocytomas and anaplastic astrocytomas (n = 19; MS, not reached vs. n = 35; MS, 40.6 months; 95% CI 22.3-59.0 months; p = 0.02). By contrast, supratotal or gross total resection was not associated with longer PFS rates in patients with IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas. Conclusions The present study demonstrates a significant association between tumor EOR and survival in patients with GII/III gliomas. The EOR cut-off value for 5-year PFS was >= 85.3%. It is noteworthy that supratotal or gross total resection significantly correlated with better PFS in IDH-mutant type of WHO grade II and III astrocytic tumors. In light of our finding that EOR did not correlate with PFS in patients with aggressive IDH-wild type of diffuse astrocytomas and anaplastic astrocytomas, we suggest treatments that are more intensive will be needed for the control of these tumors.