Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas
Role of extent of resection in the long-term outcome of low-grade hemispheric gliomas
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DOI：
10.1200/jco.2007.13.9337
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发表时间：
2008-03-10
影响因子：
45.3
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
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作者：
Smith, Justin S.;Chang, Edward F.;Berger, Mitchel S.
目的低级别胶质瘤（LGGs）切除范围（EOR）对预后的影响一直是一个有争议的问题。我们设计了一项回顾性研究，以评估EOR对LGGs.Patients和MethodsThe研究人群（N = 216）的长期结果的影响，包括成年人进行初步切除半球LGG。结果术前和术后肿瘤体积和EOR中位数分别为36.6 cm（3）（范围0.7 ~ 246.1 cm（3））、3.7 cm（3）（范围0 ~ 197.8 cm（3））和88.0%（范围5%~ 100%）。无手术死亡。在36例患者（17%）中观察到新的术后功能障碍;然而，除4例外，所有患者均完全恢复。有34例死亡（16%;中位随访时间为4.4年）。分别在95例（44%）和44例（20%）病例中确定了进展和恶性进展。EOR ≥ 90%的患者5年和8年总生存率（OS）分别为97%和91%，而EOR <90%的患者5年和8年OS率分别为76%和60%。根据年龄、Karnofsky功能评分（KPS）、肿瘤位置和肿瘤亚型调整肿瘤负荷后，通过EOR预测OS（风险比[HR] = 0.972; 95% CI，0.960至0.983; P < .001），术前肿瘤体积的对数（HR = 4.442; 95% CI，1.601 - 12.320; P = .004），术后肿瘤体积（HR = 1.010; 95%CI，1.001至1.019; P = 0.03），通过术前肿瘤体积的对数预测无进展生存期（HR = 2.711; 95%CI，1.590 - 4.623; P
PurposeThe prognostic role of extent of resection (EOR) of low-grade gliomas (LGGs) is a major controversy. We designed a retrospective study to assess the influence of EOR on long-term outcomes of LGGs.Patients and MethodsThe study population (N = 216) included adults undergoing initial resection of hemispheric LGG. Region-of-interest analysis was performed to measure tumor volumes based on fluid-attenuated inversion-recovery (FLAIR) imaging.ResultsMedian preoperative and postoperative tumor volumes and EOR were 36.6 cm(3) (range, 0.7 to 246.1 cm(3)), 3.7 cm(3) (range, 0 to 197.8 cm(3)) and 88.0% (range, 5% to 100%), respectively. There was no operative mortality. New postoperative deficits were noted in 36 patients (17%); however, all but four had complete recovery. There were 34 deaths (16%; median follow-up, 4.4 years). Progression and malignant progression were identified in 95 (44%) and 44 (20%) cases, respectively. Patients with at least 90% EOR had 5- and 8-year overall survival (OS) rates of 97% and 91%, respectively, whereas patients with less than 90% EOR had 5- and 8-year OS rates of 76% and 60%, respectively. After adjusting each measure of tumor burden for age, Karnofsky performance score (KPS), tumor location, and tumor subtype, OS was predicted by EOR (hazard ratio [HR] = 0.972; 95% CI, 0.960 to 0.983; P < .001), log preoperative tumor volume (HR = 4.442; 95% CI, 1.601 to 12.320; P = .004), and postoperative tumor volume (HR = 1.010; 95% CI, 1.001 to 1.019; P = .03), progression-free survival was predicted by log preoperative tumor volume (HR = 2.711; 95% CI, 1.590 to 4.623; P