Glioblastoma recurrence patterns near neural stem cell regions.
Glioblastoma recurrence patterns near neural stem cell regions.
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DOI：
10.1016/j.radonc.2015.07.032
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发表时间：
2015-08
期刊：
影响因子：
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通讯作者：
Redmond K
中科院分区：
文献类型：
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作者：
Chen L;Chaichana KL;Kleinberg L;Ye X;Quinones-Hinojosa A;Redmond K
胶质母细胞瘤（GBM）癌症干细胞和它们的神经干细胞对应物被假设有助于肿瘤进展。我们研究了GBM对比增强与神经源性区域（NR）的接触是否影响复发模式，因为对比增强反映了血脑屏障破坏的区域。纳入了2006年至2009年在约翰霍普金斯医院接受治疗的102例原发性GBM患者。所有患者均接受手术切除，随后接受辅助IMRT（60戈伊/30次）和伴随替莫唑胺治疗。测量了初始和复发肿瘤与室管膜下区（SVZ）或颗粒下区（SGZ）的距离。肿瘤被分类为NR接触性或非接触性。采用卡方检验分析肿瘤接触与复发模式之间的关联。49/102例（48.0%，95% CI：0.386-0.576）肿瘤在初次就诊时接触了NR，其中49/49例（100%）肿瘤在复发时接触了NR。在53例最初未接触的肿瘤中，37/53例（69.8%，95% CI：0.565-0.804）接触NR后复发。总体而言，86/102例（84.3%，95% CI：0.760-0.901）复发性GBM接触了NR，而初始表现时为49/102例（48%，95% CI：0.386-0.576）。在未接触NR的复发肿瘤中，16/53（30.1%，95% CI：0.195-0.435）例向NR内侧复发，肿瘤对比增强与NR之间的距离显著缩短。16/49（32.6%，95% CI：0.212-0.466）最初接触NR的GBM在射野外复发，而7/53（13.2%，95% CI：0.0655-0.248）最初非接触的GBM在放射治疗野外复发（p = 0.0315，比值比：3.19，95% CI：1.18-8.62）。GBM对比增强复发与邻近NR显著相关。接触NR的初始肿瘤更可能在放射治疗野外复发。
Glioblastoma (GBM) cancer stem cells and their neural stem cell counterparts are hypothesized to contribute to tumor progression. We examined whether GBM contrast enhancement contact with neurogenic regions (NR) affect recurrence patterns, as contrast enhancement reflects regions of blood–brain barrier breakdown. 102 patients with primary GBM, treated at Johns Hopkins Hospital between 2006 and 2009, were included. All patients underwent surgical resection followed by adjuvant IMRT (60 Gy/30 fractions) and concomitant temozolomide. Initial and recurrent tumor distance from the subventricular zone (SVZ) or subgranular zone (SGZ) was measured. Tumors were categorized as NR contacting or non-contacting. The chi-square test was used to analyze the association between tumor contact and recurrence pattern. 49 of 102 (48.0%, 95% CI: 0.386–0.576) tumors contacted NRs at initial presentation, and, of these tumors, 49/49 (100%) contacted NRs at recurrence. Of 53 tumors that were initially non-contacting, 37/53 (69.8%, 95% CI: 0.565–0.804) recurred contacting NRs. In total, 86/102 (84.3%, 95% CI: 0.760–0.901) recurrent GBM contacted NRs compared with 49/102 (48%, 95% CI: 0.386–0.576) at initial presentation. Of the recurrent tumors that did not contact NRs, 16/53 (30.1%, 95% CI: 0.195–0.435) recurred medially toward NRs with a significant decrease in distance between tumor contrast enhancement and NRs. 16/49 (32.6%, 95% CI: 0.212–0.466) initially NR-contacting GBMs recurred out-of field while 7/53 (13.2%, 95% CI: 0.0655–0.248) initially non-contacting recurred out of the radiation treatment field (p = 0.0315, Odds ratio: 3.19, 95% CI: 1.18–8.62). GBM contrast-enhancing recurrence is significantly associated with proximity to NRs. NR-contacting initial tumors were more likely to recur out of radiation treatment fields.