A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival
A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival
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DOI：
10.3171/jns.2001.95.2.0190
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发表时间：
2001-08-01
影响因子：
4.1
通讯作者：
Sawaya, R
中科院分区：
文献类型：
--
作者：
Lacroix, M;Abi-Said, D;Sawaya, R
目的。多形性胶质母细胞瘤（GBM）患者应进行的肿瘤切除范围仍存在争议。本研究的目的是确定这些患者生存的显着独立预测因子，并确定切除范围是否与生存时间延长相关。方法。作者回顾性分析了 1993 年 6 月至 1999 年 6 月期间在作者所在机构接受肿瘤切除术的 416 名连续患者，这些患者经组织学证实患有 GBM。前瞻性收集了磁共振 (MR) 成像识别的体积数据和其他肿瘤特征。结论。确定了五个独立的生存预测因素：年龄、卡诺夫斯基性能量表（KPS）评分、切除范围以及术前 MR 成像研究的坏死和增强程度。切除 98% 或以上肿瘤体积具有显着的生存优势（中位生存期 13 个月，95% 置信区间 [CI] 11.4-14.6 个月），而小于 98% 的切除则为 8.8 个月（95% CI 7.4-10.2 个月；p < 0.0001）。根据年龄、KPS 评分和 MR 成像上的肿瘤坏死，使用 0 到 5 的结果量表，我们观察到，接受积极切除的评分较低 (1-3) 的患者的生存期显着延长，而评分较高 (4-5) 的患者则发现生存期稍长的趋势。肿瘤全切除与 GBM 患者的较长生存期相关，特别是当其他预测变量有利时。
Object. The extent of tumor resection that should be undertaken in patients with glioblastoma multiforme (GBM) remains controversial. The purpose of this study was to identify significant independent predictors of survival in these patients and to determine whether the extent of resection was associated with increased survival time.Methods. The authors retrospectively analyzed 416 consecutive patients with histologically proven GBM who underwent tumor resection at the authors' institution between June 1993 and June 1999. Volumetric data and other tumor characteristics identified on magnetic resonance (MR) imaging were collected prospectively.Conclusions. Five independent predictors of survival were identified: age, Karnofsky Performance Scale (KPS) score, extent of resection, and the degree of necrosis and enhancement on preoperative MR imaging studies. A significant survival advantage was associated with resection of 98% or more of the tumor volume (median survival 13 months, 95% confidence interval [CI] 11.4-14.6 months), compared with 8.8 months (95% Cl 7.4-10.2 months; p < 0.0001) for resections of less than 98%. Using an outcome scale ranging from 0 to 5 based on age, KPS score, and tumor necrosis on MR imaging, we observed significantly longer survival in patients with lower scores (1-3) who underwent aggressive resections, and a trend toward slightly longer survival was found in patients with higher scores (4-5). Gross-total tumor resection is associated with longer survival in patients with GBM, especially when other predictive variables are favorable.