Multiple resections for patients with glioblastoma: prolonging survival.
Multiple resections for patients with glioblastoma: prolonging survival.
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DOI：
10.3171/2012.9.jns1277
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发表时间：
2013-04
影响因子：
4.1
通讯作者：
Quiñones-Hinojosa A
中科院分区：
文献类型：
--
作者：
Chaichana KL;Zadnik P;Weingart JD;Olivi A;Gallia GL;Blakeley J;Lim M;Brem H;Quiñones-Hinojosa A
胶质母细胞瘤是成人中最常见和最具侵袭性的原发性脑肿瘤。这些肿瘤复发，无论干预。尽管有积极的治疗，这种复发的倾向使许多人认为重复切除几乎没有用处。本研究的目的是评估与切除次数较少的患者相比，接受重复切除的患者的生存率是否有所改善，以及切除次数是否是延长生存期的独立预测因素。回顾性分析了1997年至2007年间在一家三级医疗机构接受颅内原发性胶质母细胞瘤手术的成人患者的记录。多变量比例风险回归分析用于确定胶质母细胞瘤切除次数与控制已知与生存相关的因素（如年龄、功能状态、脑室周围位置、切除范围和辅助治疗）后的生存率之间的相关性。采用Kaplan-Meier法绘制生存率与时间的关系曲线，采用对数秩分析比较生存率。578例原发性胶质母细胞瘤患者符合入选/排除标准。末次随访时，分别有354、168、41和15例患者接受了1、2、3或4次切除。接受1、2、3和4次切除的患者的中位生存期分别为6.8、15.5、22.4和26.6个月（p < 0.05）。在多变量分析中，仅接受1次切除的患者生存期缩短（相对危险度[RR] 3.400，95% CI 2.423-4.774; p < 0.0001）与接受2（RR 0.688，95% CI 0.525-0.898; p = 0.0006）、3例（RR 0.614，95% CI 0.388-0.929; p = 0.02）或4例（RR 0.600，95% CI 0.238-0.853; p = 0.01）切除。这些结果在病例对照评价中得到了验证，控制了年龄、神经功能、脑室周围肿瘤位置、切除范围和辅助治疗。接受1次、2次或3次切除的患者的中位生存期分别为4.5、16.2和24.4个月（p < 0.05）。此外，在该患者人群中，感染或医源性缺陷的风险并没有随着重复切除而增加（p > 0.05）。患有胶质母细胞瘤的患者将不可避免地经历肿瘤复发。目前的研究表明，复发性胶质母细胞瘤患者可以通过重复切除提高生存率。然而，这项研究的结果可能受到与患者选择相关的固有偏倚的限制。作者试图通过使用严格的纳入标准、多变量分析和病例对照评价来最大限度地减少这些偏倚。
Glioblastoma is the most common and aggressive type of primary brain tumor in adults. These tumors recur regardless of intervention. This propensity to recur despite aggressive therapies has made many perceive that repeated resections have little utility. The goal of this study was to evaluate if patients who underwent repeat resections experienced improved survival as compared with patients with fewer numbers of resections, and whether the number of resections was an independent predictor of prolonged survival. The records of adult patients who underwent surgery for an intracranial primary glioblastoma at an academic tertiary-care institution between 1997 and 2007 were retrospectively reviewed. Multivariate proportional-hazards regression analysis was used to identify an association between glioblastoma resection number and survival after controlling for factors known to be associated with survival, such as age, functional status, periventricular location, extent of resection, and adjuvant therapy. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analysis. Five hundred seventy-eight patients with primary glioblastoma met the inclusion/exclusion criteria. At last follow-up, 354, 168, 41, and 15 patients underwent 1, 2, 3, or 4 resections, respectively. The median survival for patients who underwent 1, 2, 3, and 4 resections was 6.8, 15.5, 22.4, and 26.6 months (p < 0.05), respectively. In multivariate analysis, patients who underwent only 1 resection experienced shortened survival (relative risk [RR] 3.400, 95% CI 2.423–4.774; p < 0.0001) as compared with patients who underwent 2 (RR 0.688, 95% CI 0.525–0.898; p = 0.0006), 3 (RR 0.614, 95% CI 0.388–0.929; p = 0.02), or 4 (RR 0.600, 95% CI 0.238–0.853; p = 0.01) resections. These results were verified in a case-control evaluation, controlling for age, neurological function, periventricular tumor location, extent of resection, and adjuvant therapy. Patients who underwent 1, 2, or 3 resections had a median survival of 4.5, 16.2, and 24.4 months, respectively (p < 0.05). Additionally, the risk of infections or iatrogenic deficits did not increase with repeated resections in this patient population (p > 0.05). Patients with glioblastoma will inevitably experience tumor recurrence. The present study shows that patients with recurrent glioblastoma can have improved survival with repeated resections. The findings of this study, however, may be limited by an intrinsic bias associated with patient selection. The authors attempted to minimize these biases by using strict inclusion criteria, multivariate analyses, and case-control evaluation.