Resection and survival in glioblastoma multiforme: An RTOG recursive partitioning analysis of ALA study patients
Resection and survival in glioblastoma multiforme: An RTOG recursive partitioning analysis of ALA study patients
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DOI：
10.1215/15228517-2008-052
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发表时间：
2008-12-01
期刊：
影响因子：
15.9
通讯作者：
Stummer, Walter
中科院分区：
文献类型：
--
作者：
Pichlmeier, Uwe;Bink, Andrea;Stummer, Walter
细胞减灭术对多形性胶质母细胞瘤（GBM）的益处尚不清楚，并且在过去的系列中观察到了选择偏差。 5-氨基乙酰丙酸 (ALA) 研究调查了荧光引导切除术对结果的影响，并生成了经过优化切除的 GBM 患者的广泛数据库。我们评估了放射治疗肿瘤学组递归分区分析 (RTOG-RPA) 是否可以预测这些患者的生存率，以及根据 RPA 类别，广泛切除是否有任何益处。共有 243 名符合方案的新诊断 GBM 患者接受了联合或不联合 ALA 的手术并接受放射治疗。所有患者均获得术后 MRI。根据年龄、KPS、神经系统状况和精神状态（源自 NIH 卒中量表），将患者分为 RTOG-RPA III-V 级。 RPA III、IV 和 V 级的中位总生存期分别为 17.8、14.7 和 10.7 个月，2 年生存率为 26%、12% 和 7% (p = 0.0007)。按切除程度分层，完全切除的 RPA IV 级和 V 级患者的生存期明显更长（17.7 个月 vs. 12.9 个月，p = 0.0015，13.7 个月 vs. 10.4 个月，p = 0.0398；2 年率：分别为 21.0% vs. 4.4% 和 11.1% vs. 2.6%），但不在 RPA III 级患者的小亚组中（19.3 个月与 16.3 个月，p = 0.14）。 RTOG-RPA 类别正确预测了 ALA 研究中患者的生存率。生存率的差异取决于切除状态，特别是在 RPA IV 级和 V 级中，支持切除对生存率的因果影响。 Neuro-Oncology 10, 1025-1034, 2008（发表于 Neuro-Oncology [在线连载]，Doc. D08-00007，2008 年 7 月 30 日。URL http://neuro-oncology.dukejournals.org；DOI：10.1215/15228517-2008-052）
The benefit of cytoreductive surgery for glioblastoma multiforme (GBM) is unclear, and selection bias in past series has been observed. The 5-aminolevulinic acid (ALA) study investigated the influence of fluorescence-guided resections on outcome and generated an extensive database of GBM patients with optimized resections. We evaluated whether the Radiation Therapy Oncology Group recursive partitioning analysis (RTOG-RPA) would predict survival of these patients and whether there was any benefit from extensive resections depending on RPA class. A total of 243 per-protocol patients with newly diagnosed GBM were operated on with or without ALA and treated by radiotherapy. Postoperative MRI was obtained in all patients. Patients were allocated into RTOG-RPA classes III-V based on age, KPS, neurological condition, and mental status (as derived from the NIH Stroke Scale). Median overall survival among RPA classes III, IV, and V was 17.8, 14.7, and 10.7 months, respectively, with 2-year survival rates of 26%, 12%, and 7% (p = 0.0007). Stratified for degree of resection, survival of patients with complete resections was clearly longer in RPA classes IV and V (17.7 months vs. 12.9 months, p = 0.0015, and 13.7 months vs. 10.4 months, p = 0.0398; 2-year rates: 21.0% vs. 4.4% and 11.1% vs. 2.6%, respectively), but was not in the small subgroup of RPA class III patients (19.3 vs. 16.3 months, p = 0.14). Survival of patients from the ALA study is correctly predicted by the RTOG-RPA classes. Differences in survival depending on resection status, especially in RPA classes IV and V, support a causal influence of resection on survival. Neuro-Oncology 10, 1025-1034, 2008 (Posted to Neuro-Oncology [serial online], Doc. D08-00007, July 30, 2008. URL http://neuro-oncology.dukejournals.org; DOI: 10.1215/15228517-2008-052)