Selection of eligible patients with supratentorial glioblastoma multiforme for gross total resection
Selection of eligible patients with supratentorial glioblastoma multiforme for gross total resection
复制标题
DOI：
10.1023/a:1010624504311
复制
发表时间：
2001-04-01
影响因子：
3.9
通讯作者：
Funakoshi, T
中科院分区：
文献类型：
--
作者：
Shinoda, J;Sakai, N;Funakoshi, T
本研究的目的是阐明肿瘤全切是否可以延长幕上多形性胶质母细胞瘤（GBM）成人患者的生存期，并阐明这些患者中哪些亚组通过肿瘤全切而获得生存优势，而术后无神经功能恶化。总体而言，中位生存时间为13个月，1年和2年生存率分别为53.7%和14.6%。在生存率的单因素分析中，年龄（<40岁），Karnofsky性能量表（KPS）评分（70 - 100%）和手术范围（大体全切除）被认为是显著的良好预后因素。考克斯比例风险多因素回归分析证实KPS和手术范围是独立的、显著的良好预后因素。9例（11%）患者术后出现神经功能恶化。最初提出了基于MRI的结合肿瘤位置、大小和邻近脑功能的局部GBM分期系统（I、II和III期）（关于分期的解释见正文）。在I期，在单变量分析中，大体全切除有一个更好的预后因素的强烈倾向，并在多变量分析中被发现是一个重要的独立的良好预后因素。同样在II期，接受大体全切除的患者的生存率优于小于大体全切除的患者，尽管不显著。在III期，没有患者接受肿瘤全切除术。总体而言，术后神经功能恶化的风险概率在I期、II期和III期分别为0%、22.2%和20%，大体全切除术后的风险概率在I期和II期分别为0%和16.7%。根治性肿瘤切除术后神经功能缺损的风险增加。为了选择一个合格的患者子集，从肿瘤全切除术中获益，无术后风险，建议采用以下GBM切除术的手术策略。I期GBM应尽可能彻底切除。至于第II期，应避免危险的手术切除延伸到邻近临界区的区域，并需要比第I期更细致和仔细的手术计划。在III期，目前不建议进行根治性大体肿瘤全切除。
The purpose of this study is to clarify whether gross total tumor resection can prolong the survival in adult patients with supratentorial glioblastoma multiforme (GBM), and to clarify what subset of these patients obtains a survival advantage by gross total tumor resection without postoperative neurological deterioration.Eighty-two adult patients with supratentorial GBM were retrospectively reviewed. Overall, the median survival time was 13 months, and the 1- and 2-year survival rates were 53.7% and 14.6%, respectively. In a univariate analysis for survival rate by log-rank test, age (< 40 years), Karnofsky performance scale (KPS) score (70-100%) and extent of surgery (gross total resection) were revealed to be significant good prognostic factors. A Cox proportional hazard multivariate regression analysis confirmed that the KPS and extent of surgery were independent, significant good prognostic factors. Nine patients (11%) suffered postoperative neurological deterioration.A topographical GBM staging system (Stages I, II and III) with the integration of tumor location, size and eloquence of adjacent brain based on MRI (for explanation of Stages see text) was originally proposed. In Stage I, gross total resection had a strong tendency toward a better prognostic factor in a univariate analysis and was revealed to be a significant independent good prognostic factor in a multivariate analysis. In also Stage II, the survival of patients who underwent gross total resection was better than that of patients with less than gross total resection, although not significant. In Stage III, there were no patients who underwent gross total tumor resection. Risk probabilities of postoperative neurological deterioration, overall, were 0%, 22.2%, and 20% in Stages I, II, and III, respectively, and those after gross total resection were 0% and 16.7% in Stages I and II, respectively.Although gross total tumor resection is associated with prolongation of the survival time of patients with GBM, the risk of postoperative neurological deficit increases with radical tumor resection. To select an eligible subset of patients that benefit in survival from gross total tumor resection without postoperative risk, the following surgical policy for GBM resection is suggested. GBM in Stage I should be resected as radically as possible. Regarding Stage II, risky surgical resection extending to the area adjacent to the critical zone should be avoided and more meticulous and careful surgical planning is needed than that in Stage I. In Stage III, radical gross total tumor resection is not recommended at present.