An extent of resection threshold for newly diagnosed glioblastomas
An extent of resection threshold for newly diagnosed glioblastomas
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DOI：
10.3171/2011.2.jns10998
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发表时间：
2011-07-01
影响因子：
4.1
通讯作者：
Berger, Mitchel S.
中科院分区：
文献类型：
--
作者：
Sanai, Nader;Polley, Mei-Yin;Berger, Mitchel S.
物体。切除范围(EOR)在改善多形性胶质母细胞瘤(GBM)患者生存方面的价值仍存在争议。具体地说，目前尚不清楚为了获得生存优势必须切除多大比例的对比剂增强的肿瘤，以及超过这一门槛后存活率提高了多少。作者试图为现代神经外科时代新诊断的GBM患者定义这些值。作者确定了1997至2009年间在加州大学旧金山分校接受治疗的连续500名新诊断的幕上GBM患者。对每个病例的临床、放射学和预后参数进行测量，包括基于磁共振成像的肿瘤体积分析。这些患者的平均年龄为60岁，卡诺夫斯基绩效评分(KPS)的中位数为80。平均临床随访期为15.3个月，无一例患者下落不明。所有患者均接受手术切除，然后进行化疗和放射治疗。术后肿瘤体积的中位数为2.3 cm(3)，相当于96%的EOR。中位总生存期为12.2个月。使用COX比例风险分析，年龄、KPS评分和EOR是生存的预测因素(p<；0.0001)。即使在95%-100%的EOR范围内，生存的逐步改善也是明显的，仅有78%的EOR被认为是显著的生存优势。一项递归分区分析验证了这些发现，并提供了与年龄、EOR和肿瘤负担相关的额外风险分层参数。对于新诊断的GBM患者，积极的EOR等同于总体存活率的改善，即使是在最高水平的切除。有趣的是，低至78%的大部切除也与生存福利相对应。(DOI：10.3171/2011.2.JNS10998)
Object. The value of extent of resection (EOR) in improving survival in patients with glioblastoma multiforme (GBM) remains controversial. Specifically, it is unclear what proportion of contrast-enhancing tumor must be resected for a survival advantage and how much survival improves beyond this threshold. The authors attempt to define these values for the patient with newly diagnosed GBM in the modern neurosurgical era.Methods. The authors identified 500 consecutive newly diagnosed patients with supratentorial GBM treated at the University of California, San Francisco between 1997 and 2009. Clinical, radiographic, and outcome parameters were measured for each case, including MR imaging-based volumetric tumor analysis.Results. The patients had a median age of 60 years and presented with a median Karnofsky Performance Scale (KPS) score of 80. The mean clinical follow-up period was 15.3 months, and no patient was unaccounted for. All patients underwent resection followed by chemotherapy and radiation therapy. The median postoperative tumor volume was 2.3 cm(3), equating to a 96% EOR. The median overall survival was 12.2 months. Using Cox proportional hazards analysis, age, KPS score, and EOR were predictive of survival (p < 0.0001). A significant survival advantage was seen with as little as 78% EOR, and stepwise improvement in survival was evident even in the 95%-100% EOR range. A recursive partitioning analysis validated these findings and provided additional risk stratification parameters related to age, EOR, and tumor burden.Conclusions. For patients with newly diagnosed GBMs, aggressive EOR equates to improvement in overall survival, even at the highest levels of resection. Interestingly, subtotal resections as low as 78% also correspond to a survival benefit. (DOI: 10.3171/2011.2.JNS10998)