Extent of Resection of Glioblastoma: A Critical Evaluation in the Molecular Era.
Extent of Resection of Glioblastoma: A Critical Evaluation in the Molecular Era.
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胶质母细胞瘤的切除程度：分子时代的关键评估。
DOI：
10.1016/j.nec.2020.09.006
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发表时间：
2021-01
影响因子：
2.6
通讯作者：
Cahill DP
中科院分区：
文献类型：
--
作者：
Cahill DP
胶质瘤手术的目的是什么？在常规的神经外科肿瘤学实践中，有两个相互交织的目标：诊断性组织采集和治疗性细胞减少。尽管缺乏“I级”证据，但越来越多的数据支持这一建议，即更广泛的手术切除在提高成年脑胶质瘤患者的存活率方面起着关键作用。随着胶质瘤遗传学的最新发现现已纳入2016年世界卫生组织(世卫组织)修订的中枢神经系统肿瘤分类，1一个关键的概念进步是认识到胶质瘤分为不同的分子群；因此，仅凭世卫组织的传统分级不能为优化手术技术提供足够的指导。借用统计学的语言，WHO2016强调需要过渡到将这些胶质瘤作为不同疾病过程的“名义”考虑，而不是将不同分级的肿瘤之间的关系视为“顺序”(即，2级、3级、4级)。简单地说，IDH突变的胶质瘤不会进展为野生型胶质母细胞瘤，需要分别重新评估手术切除这些不同类型肿瘤的证据基础。在此，我们考虑了分子时代手术切除和治疗的证据基础(表1)，重点放在3个最常见的成人弥漫性胶质瘤上：胶质母细胞瘤IDH野生型(约占成人胶质瘤的65%-70%)，星形细胞瘤IDH突变(约20%-25%)和少突胶质细胞瘤IDH突变(5%-7%)。
What is the goal of surgery for glioma? In the routine neurosurgical oncology practice there are 2 intertwined goals: diagnostic tissue acquisition and therapeutic cytoreduction. Although scant “level I” evidence exists, accumulating data support the proposal that moreextensive surgical resection has a pivotal role in improving survival in adults with glioma. With recent discoveries in glioma genetics now incorporated into the 2016 World Health Organization (WHO) Revised Classification of Tumors of the Central Nervous System, 1 a key conceptual advance has been recognition that gliomas segregate into distinct molecular groups; as a consequence, legacy WHO grading alone does not provide sufficient guidance for optimized surgical technique. Borrowing from the language of statistics, rather than considering the relationship between differently-graded tumors to be “ordinal”(ie, grades 2, 3, 4) as a stepwise progression, WHO2016 has underscored the need to transition to “nominal” consideration of these gliomas as distinct disease processes. Simply put, IDH mutant gliomas do not progress to become wild-type glioblastomas, and the evidence base for surgical resection of these different tumor types needs to be reevaluated separately. Herein, we consider the evidence base (Table 1) for surgical resection and treatment in the molecular era, with a focus on the 3 most common diffuse gliomas of adults: Glioblastoma IDH wild-type (which represents approximately 65%–70% of adult glioma), Astrocytoma IDH mutant (representing approximately 20%–25%), and Oligodendroglioma IDH mutant (5%–7%).
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DOI：
10.1093/annonc/mdx230
发表时间：
2017-08-01
期刊：
Annals of oncology : official journal of the European Society for Medical Oncology
影响因子：
--
作者：
Jakola AS;Skjulsvik AJ;Myrmel KS;Sjåvik K;Unsgård G;Torp SH;Aaberg K;Berg T;Dai HY;Johnsen K;Kloster R;Solheim O
通讯作者：
Solheim O
影响因子：
--
作者：
Killela PJ;Pirozzi CJ;Healy P;Reitman ZJ;Lipp E;Rasheed BA;Yang R;Diplas BH;Wang Z;Greer PK;Zhu H;Wang CY;Carpenter AB;Friedman H;Friedman AH;Keir ST;He J;He Y;McLendon RE;Herndon JE 2nd;Yan H;Bigner DD
通讯作者：
Bigner DD
影响因子：
120.7
作者：
Jakola, Asgeir S.;Myrmel, Kristin S.;Solheim, Ole
通讯作者：
Solheim, Ole
影响因子：
3.9
作者：
Kim, Betty Y. S.;Jiang, Wen;McCutcheon, Ian E.
通讯作者：
McCutcheon, Ian E.
影响因子：
45.3
作者：
Lassaletta, Alvaro;Zapotocky, Michal;Tabori, Uri
通讯作者：
Tabori, Uri