Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor: Results from a systematic review and meta-analysis.
Rapid early progression (REP) of glioblastoma is an independent negative prognostic factor: Results from a systematic review and meta-analysis.
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DOI：
10.1093/noajnl/vdac075
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发表时间：
2022-01
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在新诊断的胶质母细胞瘤患者中，快速早期进展（REP）是指手术和术后放化疗之间的肿瘤再生长。本系统综述和荟萃分析评估了先前发表的REP数据，以更好地描述和理解REP。系统检索了MEDLINE、EMBASE和科克伦数据库，从开始到2021年10月21日。纳入了描述新诊断胶质母细胞瘤术后MRI扫描和放疗前MRI扫描之间REP肿瘤生长发生率的研究。主要结局是REP发生率。从1590个检索结果中，纳入了9项研究，涉及716例患者。中位年龄为56.9岁（IQR 54.0-58.8岁）。男性占优势，男女比例中位数为1.4（IQR 1.1-1.5）。MRI扫描之间的中位天数为34天（IQR 18-45天）。REP的平均发生率为45.9%（范围19.3%-72.0%），在采用功能成像定义REP的研究中显著较低（P <0.001）。 REP/非REP组在年龄（P = 0.99）、性别（P = 0.33）和扫描间隔时间（P = 0.81）方面具有可比性。 REP与总生存期缩短（HR 1.78，95% CI 1.30-2.43，P <.001）、无进展生存期缩短（HR 1.78，95% CI 1.30-2.43，P <.001）、次全切除（OR 6.96，95% CI 4.51-10.73，P <.001）和IDH野生型与突变型肿瘤（OR 0.20，95% CI 0.02-0.38，P =.03）相关。 MGMT启动子甲基化与REP无关（OR 1.29，95%CI 0.72-2.28，P =.39）。 REP发生在几乎一半的新诊断的胶质母细胞瘤患者中，并具有强烈的负面预后影响。未来的研究应探讨其生物学和有效的治疗策略。
In patients with newly diagnosed glioblastoma, rapid early progression (REP) refers to tumor regrowth between surgery and postoperative chemoradiotherapy. This systematic review and meta-analysis appraised previously published data on REP to better characterize and understand it. Systematic searches of MEDLINE, EMBASE and the Cochrane database from inception to October 21, 2021. Studies describing the incidence of REP—tumor growth between the postoperative MRI scan and pre-radiotherapy MRI scan in newly diagnosed glioblastoma were included. The primary outcome was REP incidence. From 1590 search results, 9 studies were included with 716 patients. The median age was 56.9 years (IQR 54.0–58.8 y). There was a male predominance with a median male-to-female ratio of 1.4 (IQR 1.1–1.5). The median number of days between MRI scans was 34 days (IQR 18–45 days). The mean incidence rate of REP was 45.9% (range 19.3%–72.0%) and significantly lower in studies employing functional imaging to define REP (P < .001). REP/non-REP groups were comparable with respect to age (P = .99), gender (P = .33) and time between scans (P = .81). REP was associated with shortened overall survival (HR 1.78, 95% CI 1.30–2.43, P < .001), shortened progression-free survival (HR 1.78, 95% CI 1.30–2.43, P < .001), subtotal resection (OR 6.96, 95% CI 4.51–10.73, P < .001) and IDH wild-type versus mutant tumors (OR 0.20, 95% CI 0.02–0.38, P = .03). MGMT promoter methylation was not associated with REP (OR 1.29, 95% CI 0.72–2.28, P = .39). REP occurs in almost half of patients with newly diagnosed glioblastoma and has a strongly negative prognostic effect. Future studies should investigate its biology and effective treatment strategies.