Extent of resection and survival on glioblastoma multiforme-identification of and adiustment for bias
Extent of resection and survival on glioblastoma multiforme-identification of and adiustment for bias
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DOI：
10.1227/01.neu.0000317304.31579.17
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发表时间：
2008-03-01
期刊：
影响因子：
4.8
通讯作者：
Pietsch, Torsten
中科院分区：
文献类型：
--
作者：
Stummer, Walter;Reulen, Hanns-Juergen;Pietsch, Torsten
目的：手术切除程度对多形性胶质母细胞瘤患者生存率的影响仍在讨论中。高度控制的5-氨基乙酰丙酸研究为解决这个问题提供了一个独特的平台，因为荧光引导下切除的术后磁共振成像扫描和均匀的患者特征揭示了高频率的完全切除。方法：分析来自5-氨基乙酰丙酸研究方案的243例多形性胶质母细胞瘤患者。对早期磁共振成像扫描显示的完整和不完全切除的患者进行了比较。预后因素(如肿瘤大小、水肿、中线移位、肿瘤部位、年龄、Karnofsky功能量表评分、美国国立卫生研究院卒中评分)用于分析总体生存率。结果：与未完全切除(n=121)相比，完全切除(n=122)患者存在治疗偏差，即年龄较小且肿瘤部位较少。其他因素，最重要的是手术前肿瘤大小，是相同的。无肿瘤残留的患者存活时间较长(16.7mo比11.8mo，P<；0.0001)。在多变量分析中，只有残留肿瘤、年龄和Karnofsky表现量表评分对预后有显著影响。为了说明分布偏差，患者按年龄(60岁或以上)进行分层
OBJECTIVE: The influence of the degree of resection on survival in patients with glioblastoma multiforme is still under discussion. The highly controlled 5-aminolevulinic acid study provided a unique platform for addressing this question as a result of the high frequency of "complete" resections, as revealed by postoperative magnetic resonance imaging scans achieved by fluorescence-guided resection and homogeneous patient characteristics.METHODS: Two hundred forty-three patients with glioblastoma multiforme per protocol from the 5-aminolevulinic acid study were analyzed. Patients with complete and incomplete resections as revealed by early magnetic resonance imaging scans were compared. Prognostic factors that might cause bias regarding resection and influence survival (e.g., tumor size, edema, midline shift, location, age, Karnofsky Performance Scale score, National institutes of Health Stroke Scale score) were used for analysis of overall survival. Time to reintervention (chemotherapy, reoperation) was analyzed further to exclude bias regarding second-line therapies.RESULTS: Treatment bias was identified in patients with complete (n = 122) compared with incomplete resection (n = 121), i.e., younger age and less frequent eloquent tumor location. Other factors, foremost preoperative tumor size, were identical. Patients without residual tumor survived longer (16.7 versus 11.8 mo, P < 0.0001). In multivariate analysis, only residual tumor, age, and Karnofsky Performance Scale score were significantly prognostic. To account for distribution bias, patients were stratified for age (> 60 or