A mathematical model of glioma growth: The effect of extent of surgical resection
A mathematical model of glioma growth: The effect of extent of surgical resection
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DOI：
10.1111/j.1365-2184.1996.tb01580.x
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发表时间：
1996-06-01
影响因子：
8.5
通讯作者：
Alvord, EC
中科院分区：
文献类型：
--
作者：
Woodward, DE;Cook, J;Alvord, EC
我们已经开发了一个数学模型的基础上增殖和浸润的肿瘤细胞，允许预测的预期寿命以下的各种程度的手术切除的所有级别的恶性胶质瘤。模型的关键参数是增长率和扩散率。这些比率最初来自于对一例复发性间变性星形细胞瘤化疗病例的分析。数值模拟使我们能够估计如果使用不同程度的手术切除而不是化疗，该患者会发生什么。在每一种情况下，在“大体全切除”或甚至最大切除后残留的浸润性肿瘤的外壳继续生长并非常迅速地再生肿瘤块。通过开发一个模型，允许生长和扩散速率来定义诊断时细胞的分布，然后将这些速率改变约50%，我们创建了一个假设的肿瘤患者群体，其生存时间与Kreth最近报道的胶质母细胞瘤治疗结果非常一致。生长和扩散速率降低10倍，与许多其他研究者报道的生长缓慢的胶质瘤结果相似。因此，该模型定量地支持以下观点：（i）神经胶质瘤浸润如此扩散，以至于它们不能通过单独的切除术、手术或放射学来治愈，无论其可能有多广泛;（ii）切除术越广泛，无论神经胶质瘤的恶性程度如何，预期寿命越长;和（iii）测量生长和扩散这两个速率，可能能够比当前对胶质瘤类型和等级的组织学估计更好地预测存活率。
We have developed a mathematical model based on proliferation and infiltration of neoplastic cells that allows predictions to be made concerning the life expectancies following various extents of surgical resection of gliomas of all grades of malignancy. The key model parameters are the growth rate and the diffusion rate. These rates were initially derived from analysis of a case of recurrent anaplastic astrocytoma treated by chemotherapies. Numerical simulations allow us to estimate what would have happened to that patient if various extents of surgical resection, rather than chemotherapies, had been used. In each case, the shell of the infiltrating tumour that remains after 'gross total removal' or even a maximal excision continues to grow and regenerates the tumour mass remarkably rapidly. By developing a model that allows the growth and diffusion rates to define the distribution of cells at the time of diagnosis, and then varying these rates by about 50%, we created a hypothetical tumour patient population whose survival times show good agreement with the results recently reported by Kreth for treatments of glioblastomas. Tenfold decreases in the rates of growth and diffusion mimic the results reported by many other investigators with more slowly growing gliomas. Thus, the model quantitatively supports the ideas that (i) gliomas infiltrate so diffusely that they cannot be cured by resection alone, surgical or radiological, no matter how extensive that may be; (ii) the more extensive the resection, regardless of the degree of malignancy of the glioma, the greater the life expectancy; and (iii) measurements of the two rates, growth and diffusion, may be able to predict survival rates better than the current histological estimates of the type and grade of gliomas.