Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance
Correlation of the extent of tumor volume resection and patient survival in surgery of glioblastoma multiforme with high-field intraoperative MRI guidance
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DOI：
10.1093/neuonc/nor133
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发表时间：
2011-12-01
期刊：
影响因子：
15.9
通讯作者：
Nimsky, Christopher
中科院分区：
文献类型：
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作者：
Kuhnt, Daniela;Becker, Andreas;Nimsky, Christopher
在多形性胶质母细胞瘤(GBM)的治疗中，切除范围(EOR)仍然存在争议。然而，越来越多的研究倾向于最大限度地提高EOR，因为这与患者更长的生存期有关。135例基底膜患者在术中1.5T磁共振成像(IMRI)和多模式导航的辅助下完成了肿瘤切除手术。肿瘤体积通过手动分割进行量化。分析EOR、患者年龄、复发肿瘤、肿瘤部位和性别对生存时间的影响。术中MRI检出肿瘤残留体积88例。19例继续手术，9例最终大部切除(GTR47例，占34.80%；56例，占41.49%)。肿瘤体积由34.25+/-23.68%(首次iMRI)降至1.22+/-16.24%(最终iMRI)。根据Kaplan-Meier的估计，EOR=98%的中位生存期为14个月(95%可信区间：11.7-16.2)，98%(P<；.0001)的中位生存期为9个月(95%可信区间：7.4-10.5)；=65岁12个月(95%可信区间：8.4~15.6)；65岁以下患者=0.61(95%可信区间：0.38~0.97；P<；0.05)。据我们所知，这是包括iMRI、肿瘤体积测量和生存时间相关性在内的最大规模的研究。我们证明，导航引导和iMRI显著有助于以较低的术后发病率实现最佳的EOR，其中EOR和Gt；=98%以及患者年龄和65岁与显著的生存优势相关。因此，在保留神经功能的同时，最大限度地提高EOR应是GBM手术的手术目标。
Extent of resection (EOR) still remains controversial in therapy of glioblastoma multiforme (GBM). However, an increasing number of studies favor maximum EOR as being associated with longer patient survival. One hundred thirty-five GBM patients underwent tumor resection aided by 1.5T intraoperative MRI (iMRI) and integrated multimodal navigation. Tumor volume was quantified by manual segmentation. The influences of EOR, patient age, recurrent tumor, tumor localization, and gender on survival time were examined. Intraoperative MRI detected residual tumor volume in 88 patients. In 19 patients surgery was continued; further resection resulted in final gross total resection (GTR) for 9 patients (GTR increased from 47 [34.80%] to 56 [41.49%] patients). Tumor volumes were significantly reduced from 34.25 +/- 23.68% (first iMRI) to 1.22 +/- 16.24% (final iMRI). According to Kaplan-Meier estimates, median survival was 14 months (95% confidence interval [CI]: 11.7-16.2) for EOR >= 98% and 9 months (95% CI: 7.4-10.5) for EOR < 98% (P < .0001); it was 9 months (95% CI: 7.3-10.7) for patients >= 65 years and 12 months (95% CI: 8.4-15.6) for patients = 98% and 0.61 (95% CI: 0.38-0.97; P < .05) for patient age < 65 years. To our knowledge, this is the largest study including correlation of iMRI, tumor volumetry, and survival time. We demonstrate that navigation guidance and iMRI significantly contribute to optimal EOR with low postoperative morbidity, where EOR >= 98% and patient age < 65 years are associated with significant survival advantages. Thus, maximum EOR should be the surgical goal in GBM surgery while preserving neurological function.